Provider Demographics
NPI:1760960256
Name:LI, NOVA DANNUO (DDS)
Entity type:Individual
Prefix:
First Name:NOVA
Middle Name:DANNUO
Last Name:LI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 S HACIENDA BLVD APT 78
Mailing Address - Street 2:
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-4718
Mailing Address - Country:US
Mailing Address - Phone:626-554-5748
Mailing Address - Fax:
Practice Address - Street 1:113 WATERWORKS WAY STE 335
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3173
Practice Address - Country:US
Practice Address - Phone:949-889-0006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-06
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1029021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice