MEDICARE: LI SAGE ACUPUNCTURE CLINIC

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	LAC8155	CA

General Provider Information

NPI Number	:	1952587438
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LI SAGE ACUPUNCTURE CLINIC

Provider Business Mailing Address
First Line	:	1017 S. SAN GABRIEL BL
Second Line	:
City	:	SAN GABRIEL
State	:	CA
Zip	:	91776
Country	:	US
Telephone Number	:	626-203-9372
Fax Number	:

Provider Business Practice Location Address
First Line	:	1017 S SAN GABRIEL BLVD
Second Line	:
City	:	SAN GABRIEL
State	:	CA
Zip	:	91776-3112
Country	:	US
Telephone Number	:	626-203-9372
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JIJUAN LI
Credential	:	LAC
Telephone Number	:	626-203-9372

Provider Enumeration Date	:	01/15/2008
Last Update Date	:	01/15/2008

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