Provider Demographics
NPI:1740691245
Name:LI, LIJUAN (DIPL OM)
Entity type:Individual
Prefix:
First Name:LIJUAN
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:DIPL OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1413 MCCLURE DR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-4002
Mailing Address - Country:US
Mailing Address - Phone:214-326-2195
Mailing Address - Fax:
Practice Address - Street 1:101 W MCDERMOTT DR
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-2751
Practice Address - Country:US
Practice Address - Phone:214-326-2195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-19
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist