Healthcare Provider Details

I. General information

NPI: 1821532581
Provider Name (Legal Business Name): SHIRLEY LI L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2016
Last Update Date: 12/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11650 RIVERSIDE DR SUITE #PH1
STUDIO CITY CA
91602-1093
US

IV. Provider business mailing address

61 S BALDWIN AVE # 242
SIERRA MADRE CA
91024-2553
US

V. Phone/Fax

Practice location:
  • Phone: 626-755-0213
  • Fax:
Mailing address:
  • Phone: 626-422-4035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC17306
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: