Provider Demographics
NPI:1841577343
Name:LI, RUSONG (LAC)
Entity Type:Individual
Prefix:
First Name:RUSONG
Middle Name:
Last Name:LI
Suffix:
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 1:1330 NEW HAMPSHIRE AVE NW
Mailing Address - Street 2:SUITE B-5
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-6350
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1330 NEW HAMPSHIRE AVE NW
Practice Address - Street 2:SUITE B-5
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-6350
Practice Address - Country:US
Practice Address - Phone:732-642-1625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-11
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCAC500116171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist