Provider Demographics
NPI:1114180692
Name:LI, YONG (LIC, A)
Entity Type:Individual
Prefix:MR
First Name:YONG
Middle Name:
Last Name:LI
Suffix:
Gender:M
Credentials:LIC, A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5150 BUFORD HWY NE
Mailing Address - Street 2:SUITE C180
Mailing Address - City:DORAVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30340-1153
Mailing Address - Country:US
Mailing Address - Phone:770-936-8603
Mailing Address - Fax:678-339-0817
Practice Address - Street 1:5150 BUFORD HWY NE
Practice Address - Street 2:SUITE C180
Practice Address - City:DORAVILLE
Practice Address - State:GA
Practice Address - Zip Code:30340-1153
Practice Address - Country:US
Practice Address - Phone:770-936-8603
Practice Address - Fax:678-339-0817
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-06
Last Update Date:2008-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000024171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist