Healthcare Provider Details

I. General information

NPI: 1013084748
Provider Name (Legal Business Name): LI LI CAI LIC. AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

464 COMMONWEALTH AVE APT. NO. 16
BOSTON MA
02215-2701
US

IV. Provider business mailing address

73 LAKEVIEW AVE
NEWTON MA
02460-2349
US

V. Phone/Fax

Practice location:
  • Phone: 617-670-0428
  • Fax:
Mailing address:
  • Phone: 617-670-0428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number588
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: