Provider Demographics
NPI:1255685343
Name:LI, DONGCHENG (AP)
Entity Type:Individual
Prefix:
First Name:DONGCHENG
Middle Name:
Last Name:LI
Suffix:
Gender:M
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9235 LAGOON PL APT 410
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33324-6729
Mailing Address - Country:US
Mailing Address - Phone:954-647-5531
Mailing Address - Fax:
Practice Address - Street 1:7730 PETERS RD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-4004
Practice Address - Country:US
Practice Address - Phone:954-647-5531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-29
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2875171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist