Provider Demographics
NPI:1760563365
Name:LI, EDWARD KIN (DC)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:KIN
Last Name:LI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:388 9TH ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-4287
Mailing Address - Country:US
Mailing Address - Phone:510-452-0889
Mailing Address - Fax:510-452-0912
Practice Address - Street 1:388 9TH ST
Practice Address - Street 2:SUITE 208
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-4287
Practice Address - Country:US
Practice Address - Phone:510-452-0889
Practice Address - Fax:510-452-0912
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC014126111N00000X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA942986904OtherTAX NUMBER
CADC014126OtherLICENSE NUMBER
CA942986904OtherTAX NUMBER