Provider Demographics
NPI:1376898254
Name:LI, HONG (LAC)
Entity Type:Individual
Prefix:MR
First Name:HONG
Middle Name:
Last Name:LI
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:382 S LEMON AVE
Mailing Address - Street 2:B
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-2715
Mailing Address - Country:US
Mailing Address - Phone:626-922-3382
Mailing Address - Fax:909-595-2628
Practice Address - Street 1:382 S LEMON AVE
Practice Address - Street 2:B
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-2715
Practice Address - Country:US
Practice Address - Phone:626-922-3382
Practice Address - Fax:909-595-2628
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC6801171100000X
171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC6801OtherACUPUNCTURIST