Provider Demographics
NPI:1790827756
Name:LI, FANJIN (OMD)
Entity Type:Individual
Prefix:DR
First Name:FANJIN
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:347 HEAD ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94132-3111
Mailing Address - Country:US
Mailing Address - Phone:415-990-9571
Mailing Address - Fax:415-587-7698
Practice Address - Street 1:161 E BLITHEDALE AVE
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-2029
Practice Address - Country:US
Practice Address - Phone:415-990-9571
Practice Address - Fax:415-587-7698
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9175171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist