MEDICARE: LIPING HOLST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	347C00000X	Private Vehicle	7GFX328	CA

General Provider Information

NPI Number	:	1053873414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIPING HOLST

Provider Business Mailing Address
First Line	:	850 ANTELOPE MOUNTAIN DR
Second Line	:
City	:	BIG BEAR CITY
State	:	CA
Zip	:	92314-8914
Country	:	US
Telephone Number	:	909-584-7236
Fax Number	:

Provider Business Practice Location Address
First Line	:	850 ANTELOPE MOUNTAIN DR
Second Line	:
City	:	BIG BEAR CITY
State	:	CA
Zip	:	92314-8914
Country	:	US
Telephone Number	:	909-584-7236
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2019
Last Update Date	:	04/04/2019

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Directions to “ LIPING HOLST ” Practice Location

Language	Start Address	Practice Location

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