MEDICARE: DR. KEBIN LI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist

General Provider Information

NPI Number	:	1710526603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEBIN LI

Provider Business Mailing Address
First Line	:	32759 CLEAR LAKE ST
Second Line	:
City	:	FREMONT
State	:	CA
Zip	:	94555-1012
Country	:	US
Telephone Number	:	510-552-9431
Fax Number	:

Provider Business Practice Location Address
First Line	:	2905 STENDER WAY STE 46
Second Line	:
City	:	SANTA CLARA
State	:	CA
Zip	:	95054-3224
Country	:	US
Telephone Number	:	510-552-9431
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/25/2019
Last Update Date	:	12/26/2019

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