Provider Demographics
NPI:1417836313
Name:LI, SHURONG (DOM, LAC)
Entity type:Individual
Prefix:
First Name:SHURONG
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:DOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8727 TIERRA ALEGRE DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-2643
Mailing Address - Country:US
Mailing Address - Phone:505-900-8886
Mailing Address - Fax:
Practice Address - Street 1:8727 TIERRA ALEGRE DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87122-2643
Practice Address - Country:US
Practice Address - Phone:505-900-8886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-27
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMAOM-2024-0032171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist