Provider Demographics
NPI:1750659785
Name:LAM, SHI QI (LAC, LMT)
Entity Type:Individual
Prefix:
First Name:SHI QI
Middle Name:
Last Name:LAM
Suffix:
Gender:M
Credentials:LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2073 76TH STREET
Mailing Address - Street 2:FL 1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-1349
Mailing Address - Country:US
Mailing Address - Phone:718-915-8789
Mailing Address - Fax:
Practice Address - Street 1:2073 76TH STREET
Practice Address - Street 2:FL 1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-1349
Practice Address - Country:US
Practice Address - Phone:718-915-8789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004718171100000X
NY024314225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist