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General NPI Number Information
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NPI Number | 1922735547
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Entity Type | Individual
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Provider Name | SUNG LI LMT
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Gender | Male
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Dates
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Enumeration Date | 08/03/2022
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Last Update Date | 08/03/2022
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Provider Practice Location Address
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Address Line | 651 HIGH ST NE STE 110
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City | SALEM
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State | OR
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Zip | 97301-2490
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Country | US
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Telephone | 503-689-6658
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Fax |
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Provider Business Mailing Address
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Address Line | 620 36TH AVE NE
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City | SALEM
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State | OR
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Zip | 97301-4740
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Country | US
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Telephone | 707-592-5361
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | LMT-25161
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License Number State | OR
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