Provider Demographics
NPI:1871638189
Name:LI, SHAOZHEN (LAC)
Entity Type:Individual
Prefix:
First Name:SHAOZHEN
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 1:2823 E MAIN
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-3167
Mailing Address - Country:US
Mailing Address - Phone:253-848-1736
Mailing Address - Fax:253-445-0879
Practice Address - Street 1:2823 E MAIN
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3167
Practice Address - Country:US
Practice Address - Phone:253-848-1736
Practice Address - Fax:253-445-0879
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00000183171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist