Provider Demographics
NPI:1932268794
Name:WANG, LI (LAC, PHD)
Entity Type:Individual
Prefix:DR
First Name:LI
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:LAC, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8120 PENN AVE S STE 419
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-1351
Mailing Address - Country:US
Mailing Address - Phone:952-224-9610
Mailing Address - Fax:952-224-9610
Practice Address - Street 1:8120 PENN AVE S STE 419
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-1351
Practice Address - Country:US
Practice Address - Phone:952-224-9610
Practice Address - Fax:952-224-9610
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1365171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN122190Medicare UPIN