MEDICARE: LI LIN

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	171100000X	Acupuncturist	1117	CO

General Provider Information

NPI Number	:	1063794675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LI LIN

Provider Business Mailing Address
First Line	:	PO BOX 21435
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80308-4435
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	775 POPLAR AVE
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80304-1067
Country	:	US
Telephone Number	:	303-842-3644
Fax Number	:

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

Provider Enumeration Date	:	09/09/2011
Last Update Date	:	04/18/2014

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Directions to “ LI LIN ” Practice Location

Language	Start Address	Practice Location

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