Provider Demographics
NPI:1174192017
Name:ZHANG, LI (LAC, DIPL OM)
Entity Type:Individual
Prefix:MR
First Name:LI
Middle Name:
Last Name:ZHANG
Suffix:
Gender:M
Credentials:LAC, DIPL OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5710 JUNCTION BLVD APT 2H
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-5164
Mailing Address - Country:US
Mailing Address - Phone:929-283-1942
Mailing Address - Fax:
Practice Address - Street 1:19 W 45TH ST STE 501
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-4904
Practice Address - Country:US
Practice Address - Phone:929-283-1942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-24
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006876-01171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist