Healthcare Provider Details

I. General information

NPI: 1295722692
Provider Name (Legal Business Name): LI QI L AC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 W 94TH ST CHILI ACUPUNCTURE CENTER
NEW YORK NY
10025-6945
US

IV. Provider business mailing address

257 W 94TH ST CHILI ACUPUNCTURE CENTER
NEW YORK NY
10025-6945
US

V. Phone/Fax

Practice location:
  • Phone: 212-662-8886
  • Fax: 212-662-6886
Mailing address:
  • Phone: 212-662-8886
  • Fax: 212-662-6886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1333
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: