Healthcare Provider Details

I. General information

NPI: 1275027237
Provider Name (Legal Business Name): ZIQI LI LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2018
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date: 11/11/2019
Reactivation Date: 06/11/2026

III. Provider practice location address

1800 SULLIVAN AVE RM 106
DALY CITY CA
94015-2227
US

IV. Provider business mailing address

1800 SULLIVAN AVE RM 106
DALY CITY CA
94015-2227
US

V. Phone/Fax

Practice location:
  • Phone: 650-507-4113
  • Fax: 650-507-4286
Mailing address:
  • Phone: 650-507-4113
  • Fax: 650-507-4286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number17996
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: