Provider Demographics
NPI:1134384399
Name:LI, SHENGWEN (LIC, AC)
Entity type:Individual
Prefix:MR
First Name:SHENGWEN
Middle Name:
Last Name:LI
Suffix:
Gender:M
Credentials:LIC, AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 W WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90018-1402
Mailing Address - Country:US
Mailing Address - Phone:323-731-8800
Mailing Address - Fax:323-731-8850
Practice Address - Street 1:2211 W WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90018-1402
Practice Address - Country:US
Practice Address - Phone:323-731-8800
Practice Address - Fax:323-731-8850
Is Sole Proprietor?:No
Enumeration Date:2008-07-26
Last Update Date:2008-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 9625171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist