Provider Demographics
NPI:1790278299
Name:LI, SHUJIAO (ACCUPUNTURE)
Entity Type:Individual
Prefix:MS
First Name:SHUJIAO
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:ACCUPUNTURE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20132 EMERALD MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-3511
Mailing Address - Country:US
Mailing Address - Phone:626-260-5579
Mailing Address - Fax:
Practice Address - Street 1:20132 EMERALD MEADOW DR
Practice Address - Street 2:
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-3511
Practice Address - Country:US
Practice Address - Phone:626-260-5579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-08
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC18070171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty