Provider Demographics
NPI:1003962135
Name:MA, LI (DO)
Entity Type:Individual
Prefix:
First Name:LI
Middle Name:
Last Name:MA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22227 REDWOOD RD
Mailing Address - Street 2:#A
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546
Mailing Address - Country:US
Mailing Address - Phone:510-881-1198
Mailing Address - Fax:510-773-4944
Practice Address - Street 1:22227 REDWOOD RD
Practice Address - Street 2:#A
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546
Practice Address - Country:US
Practice Address - Phone:510-881-1198
Practice Address - Fax:510-773-4944
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALAC9222ACUPUNCTURIST171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist