Provider Demographics
NPI:1821213919
Name:WU, LI LI (LIAC)
Entity Type:Individual
Prefix:
First Name:LI LI
Middle Name:
Last Name:WU
Suffix:
Gender:F
Credentials:LIAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 WEST 24 STREET
Mailing Address - Street 2:#1D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011
Mailing Address - Country:US
Mailing Address - Phone:212-741-6674
Mailing Address - Fax:
Practice Address - Street 1:420 WEST 24 STREET
Practice Address - Street 2:#1D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011
Practice Address - Country:US
Practice Address - Phone:718-439-8805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000219171100000X
MA288171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY009181OtherBLUE CROSS
NY009182OtherBLUE CROSS
NYP613665OtherOXFORD