Provider Demographics
NPI:1467921528
Name:DENG, LIJIN (LAC)
Entity Type:Individual
Prefix:
First Name:LIJIN
Middle Name:
Last Name:DENG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 CONCOURSE DR STE 66
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95131-1895
Mailing Address - Country:US
Mailing Address - Phone:408-597-2261
Mailing Address - Fax:408-904-5056
Practice Address - Street 1:5131 MOORPARK AVE STE 303
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-2100
Practice Address - Country:US
Practice Address - Phone:408-597-2261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-19
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC18234171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist