Provider Demographics
NPI:1821532581
Name:LI, SHIRLEY (LAC)
Entity Type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 S BALDWIN AVE
Mailing Address - Street 2:# 242
Mailing Address - City:SIERRA MADRE
Mailing Address - State:CA
Mailing Address - Zip Code:91024-2553
Mailing Address - Country:US
Mailing Address - Phone:626-422-4035
Mailing Address - Fax:
Practice Address - Street 1:11650 RIVERSIDE DR
Practice Address - Street 2:SUITE #PH1
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91602-1093
Practice Address - Country:US
Practice Address - Phone:626-755-0213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-14
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC17306171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist