MEDICARE: PING LI L.AC, L.M.T

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	AC01604	TX

General Provider Information

NPI Number	:	1740661263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PING LI L.AC, L.M.T

Provider Business Mailing Address
First Line	:	1305 CAMP CRAFT RD
Second Line	:	APT C
City	:	WEST LAKE HILLS
State	:	TX
Zip	:	78746-6983
Country	:	US
Telephone Number	:	571-258-9858
Fax Number	:

Provider Business Practice Location Address
First Line	:	3530 BEE CAVE RD
Second Line	:	SUITE 212
City	:	AUSTIN
State	:	TX
Zip	:	78746
Country	:	US
Telephone Number	:	571-258-9858
Fax Number	:

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

Provider Enumeration Date	:	06/10/2015
Last Update Date	:	06/10/2015

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