Provider Demographics
NPI:1114069739
Name:LI, JING (LAC, MD DIPL AC)
Entity Type:Individual
Prefix:MS
First Name:JING
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:LAC, MD DIPL AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 TRADE ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-8190
Mailing Address - Country:US
Mailing Address - Phone:630-854-7084
Mailing Address - Fax:630-898-9378
Practice Address - Street 1:95 TRADE ST
Practice Address - Street 2:SUITE 102
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-8190
Practice Address - Country:US
Practice Address - Phone:630-854-7084
Practice Address - Fax:630-898-9378
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist