=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285053942
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HONGYAN LI O.M.D, M.D(CN)
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/10/2014
-----------------------------------------------------
Last Update Date | 09/21/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5435 BALBOA BLVD STE 207
-----------------------------------------------------
City | ENCINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91316-1576
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-736-7365
-----------------------------------------------------
Fax | 818-345-9104
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5435 BALBOA BLVD STE 207
-----------------------------------------------------
City | ENCINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91316-1576
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-736-7365
-----------------------------------------------------
Fax | 818-345-9104
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 15966
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------