Provider Demographics
NPI:1659664944
Name:LI, XINSONG N/A (LAC)
Entity Type:Individual
Prefix:MS
First Name:XINSONG
Middle Name:N/A
Last Name:LI
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
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Mailing Address - Street 1:9908 ABBOTT AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55431-2714
Mailing Address - Country:US
Mailing Address - Phone:952-297-5600
Mailing Address - Fax:952-224-0152
Practice Address - Street 1:1660 HIGHWAY 100 S STE 338
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-1573
Practice Address - Country:US
Practice Address - Phone:952-297-5600
Practice Address - Fax:952-224-0152
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-19
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN1287171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist