Provider Demographics
NPI:1952520272
Name:KEAN, BAILING LI (LIC AC)
Entity Type:Individual
Prefix:
First Name:BAILING
Middle Name:LI
Last Name:KEAN
Suffix:
Gender:F
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 1:425 UNION ST #15
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-4108
Mailing Address - Country:US
Mailing Address - Phone:413-788-9888
Mailing Address - Fax:
Practice Address - Street 1:425 UNION ST #15
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-4108
Practice Address - Country:US
Practice Address - Phone:413-788-9888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA203390171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist