Healthcare Provider Details

I. General information

NPI: 1386762532
Provider Name (Legal Business Name): JENNY SHAW LI L.AC, PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177 DARCY PKWY
LATHROP CA
95330-9222
US

IV. Provider business mailing address

177 DARCY PKWY
LATHROP CA
95330-9222
US

V. Phone/Fax

Practice location:
  • Phone: 209-858-5832
  • Fax:
Mailing address:
  • Phone: 209-858-5832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC9158
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: