Healthcare Provider Details

I. General information

NPI: 1700960481
Provider Name (Legal Business Name): JIJUAN LI LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

623 W DUARTE RD # 2A
ARCADIA CA
91007-7330
US

IV. Provider business mailing address

623 W DUARTE RD # 2A
ARCADIA CA
91007-7330
US

V. Phone/Fax

Practice location:
  • Phone: 626-254-8958
  • Fax: 626-254-8558
Mailing address:
  • Phone: 626-254-8958
  • Fax: 626-254-8558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberLAC # 8155
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: