Basic Information
| Provider Information | |||||||||
| NPI: | 1679776223 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | LI | ||||||||
| FirstName: | DAYUAN | ||||||||
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| Credential: | MD, PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10122 POWERS LAKE TRL | ||||||||
| Address2: | |||||||||
| City: | WOODBURY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551298589 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4349739178 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1700 UNIVERSITY AVE W FL 6 | ||||||||
| Address2: | |||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551043727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512322273 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2007 | ||||||||
| LastUpdateDate: | 04/27/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 0101242621 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 390200000X | 0116019093 | VA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207RC0000X | 53941 | MN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 302011 | 01 | VA | ANTHEM | OTHER | 1679776223 | 05 | VA | MEDICAID | 9239107 | 01 | VA | AETNA | OTHER | 7389041 | 01 | VA | CIGNA | OTHER |