Provider Demographics
NPI:1508943945
Name:LI, YAN-XIANG (LAC)
Entity Type:Individual
Prefix:
First Name:YAN-XIANG
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:YAN
Other - Middle Name:
Other - Last Name:LI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACUPUNCTURIST
Mailing Address - Street 1:5851 MISSION ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112-4017
Mailing Address - Country:US
Mailing Address - Phone:415-337-6088
Mailing Address - Fax:415-337-6638
Practice Address - Street 1:5851 MISSION ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94112-4017
Practice Address - Country:US
Practice Address - Phone:415-337-6088
Practice Address - Fax:415-337-6638
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC2763171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0027630OtherMEDI-CAL #