Provider Demographics
NPI:1598090706
Name:LI, CHUN (LA,C)
Entity Type:Individual
Prefix:
First Name:CHUN
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:LA,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1124 FARNSWORTH RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-5419
Mailing Address - Country:US
Mailing Address - Phone:917-517-0928
Mailing Address - Fax:
Practice Address - Street 1:2024 W HENRIETTA RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-1355
Practice Address - Country:US
Practice Address - Phone:585-272-7340
Practice Address - Fax:585-272-0562
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-05
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003648171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist