Provider Demographics
NPI:1447331905
Name:LI, TIN WAI (DDS)
Entity type:Individual
Prefix:
First Name:TIN
Middle Name:WAI
Last Name:LI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10801 MAIN ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-4727
Mailing Address - Country:US
Mailing Address - Phone:703-815-2041
Mailing Address - Fax:703-345-0487
Practice Address - Street 1:10801 MAIN ST
Practice Address - Street 2:SUITE 500
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-4727
Practice Address - Country:US
Practice Address - Phone:703-815-2041
Practice Address - Fax:703-345-0487
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401006274122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist