=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235527821
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JUN LI
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/05/2015
-----------------------------------------------------
Last Update Date | 11/13/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1931 ROHLWING RD STE F
-----------------------------------------------------
City | ROLLING MEADOWS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60008-1360
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-271-9406
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1504 DELLA DR
-----------------------------------------------------
City | HOFFMAN ESTATES
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60169-6959
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-271-9406
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 198.001168
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------