Healthcare Provider Details

I. General information

NPI: 1790278299
Provider Name (Legal Business Name): SHUJIAO LI ACCUPUNTURE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2018
Last Update Date: 06/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20132 EMERALD MEADOW DR
WALNUT CA
91789-3511
US

IV. Provider business mailing address

20132 EMERALD MEADOW DR
WALNUT CA
91789-3511
US

V. Phone/Fax

Practice location:
  • Phone: 626-260-5579
  • Fax:
Mailing address:
  • Phone: 626-260-5579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC18070
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: