Provider Demographics
NPI:1518089697
Name:KO, JING LIH (L AC)
Entity Type:Individual
Prefix:MS
First Name:JING LIH
Middle Name:
Last Name:KO
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 W VALLEY BLVD STE 67
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91803-3243
Mailing Address - Country:US
Mailing Address - Phone:626-284-6885
Mailing Address - Fax:
Practice Address - Street 1:701 W VALLEY BLVD STE 67
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91803-3243
Practice Address - Country:US
Practice Address - Phone:626-284-6885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC7832171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3283933Medicaid
CAAC7832OtherL. AC.