Healthcare Provider Details

I. General information

NPI: 1881512614
Provider Name (Legal Business Name): LIVING BREATH CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12035 ANDERSON RD
WILLIS TX
77318-5511
US

IV. Provider business mailing address

12619 PEGASUS DR
WILLIS TX
77318-5074
US

V. Phone/Fax

Practice location:
  • Phone: 281-818-9996
  • Fax:
Mailing address:
  • Phone: 281-871-9516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: WEN JUN WENDY SHI
Title or Position: OWNER
Credential: LAC
Phone: 281-871-9516