MEDICARE: KUN LI

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	225700000X	Massage Therapist	033737	NY

General Provider Information

NPI Number	:	1407677289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KUN LI

Provider Business Mailing Address
First Line	:	2619 141ST ST APT 6F
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11354-1624
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	23A MIDDLE NECK RD
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11021-2319
Country	:	US
Telephone Number	:	917-362-3868
Fax Number	:

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

Provider Enumeration Date	:	10/23/2024
Last Update Date	:	10/23/2024

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Directions to “ KUN LI ” Practice Location

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