Healthcare Provider Details

I. General information

NPI: 1801033857
Provider Name (Legal Business Name): LLY ACUPUNCTURE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2009
Last Update Date: 01/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7020 TRASK AVE
WESTMINSTER CA
92683-2622
US

IV. Provider business mailing address

7020 TRASK AVE
WESTMINSTER CA
92683-2622
US

V. Phone/Fax

Practice location:
  • Phone: 714-698-2621
  • Fax: 714-698-2621
Mailing address:
  • Phone: 714-698-2621
  • Fax: 714-698-2621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC6047
License Number StateCA

VIII. Authorized Official

Name: LILY DANZHI LI
Title or Position: ACUPUNCTURIST
Credential: L,AC
Phone: 714-698-2621