Provider Demographics
NPI:1083843445
Name:LI, SHIN MIN (LAC)
Entity Type:Individual
Prefix:MR
First Name:SHIN MIN
Middle Name:
Last Name:LI
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
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Mailing Address - Street 1:31852 COAST HWY
Mailing Address - Street 2:STE 307
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-6764
Mailing Address - Country:US
Mailing Address - Phone:949-415-0199
Mailing Address - Fax:949-415-0199
Practice Address - Street 1:31852 COAST HWY
Practice Address - Street 2:STE 307
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-6764
Practice Address - Country:US
Practice Address - Phone:949-415-0199
Practice Address - Fax:949-415-0199
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-07
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAAC 1038171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist