Provider Demographics
NPI:1831593938
Name:LI, QIAN (LAC)
Entity type:Individual
Prefix:
First Name:QIAN
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 1:14480 SANFORD AVE APT 6L
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-6303
Mailing Address - Country:US
Mailing Address - Phone:646-289-0531
Mailing Address - Fax:
Practice Address - Street 1:14480 SANFORD AVE APT 6L
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-6303
Practice Address - Country:US
Practice Address - Phone:646-289-0531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005165171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
005165OtherACUPUNCTURE LICENSE