Provider Demographics
NPI:1710907449
Name:LI, TINGAN (LAC)
Entity Type:Individual
Prefix:
First Name:TINGAN
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:
Other - Last Name:LI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:4108 MOLLER DR
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-8440
Mailing Address - Country:US
Mailing Address - Phone:510-651-7622
Mailing Address - Fax:925-600-1388
Practice Address - Street 1:39953 BALENTINE DR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:CA
Practice Address - Zip Code:94560-5373
Practice Address - Country:US
Practice Address - Phone:510-651-7622
Practice Address - Fax:866-573-7421
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC7225171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA171100000-AC7225OtherTAXONOMY
CA171100000-AC7225OtherTAXONOMY