MEDICARE: MR. SHENGWEN LI LIC., AC

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	AC 9625	CA

General Provider Information

NPI Number	:	1134384399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SHENGWEN LI LIC., AC

Provider Business Mailing Address
First Line	:	2211 W WASHINGTON BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90018-1402
Country	:	US
Telephone Number	:	323-731-8800
Fax Number	:	323-731-8850

Provider Business Practice Location Address
First Line	:	2211 W WASHINGTON BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90018-1402
Country	:	US
Telephone Number	:	323-731-8800
Fax Number	:	323-731-8850

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

Provider Enumeration Date	:	07/26/2008
Last Update Date	:	07/26/2008

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