Provider Demographics
NPI:1821257015
Name:LI, CHENG SI SR (LAC)
Entity Type:Individual
Prefix:DR
First Name:CHENG
Middle Name:SI
Last Name:LI
Suffix:SR
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19231 VICTORY BLVD STE 251
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-6364
Mailing Address - Country:US
Mailing Address - Phone:818-430-2428
Mailing Address - Fax:818-758-1788
Practice Address - Street 1:19231 VICTORY BLVD STE 251
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-6364
Practice Address - Country:US
Practice Address - Phone:818-430-2428
Practice Address - Fax:818-758-1788
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL.AC 9402171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist