Provider Demographics
NPI:1629193990
Name:LI, JESSICA TAO (PHD)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:TAO
Last Name:LI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2923 SHORESIDE DR
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7183
Mailing Address - Country:US
Mailing Address - Phone:713-436-7178
Mailing Address - Fax:713-436-7178
Practice Address - Street 1:427 W 20TH ST STE 209
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-2400
Practice Address - Country:US
Practice Address - Phone:832-526-3660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC00924171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist