Provider Demographics
NPI:1902304397
Name:LI, WENJIN (LAC)
Entity Type:Individual
Prefix:
First Name:WENJIN
Middle Name:
Last Name:LI
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:MARK
Other - Middle Name:
Other - Last Name:LI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:300 OLD POND RD STE 201
Mailing Address - Street 2:
Mailing Address - City:BRIDGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15017-1270
Mailing Address - Country:US
Mailing Address - Phone:412-220-7323
Mailing Address - Fax:412-220-7325
Practice Address - Street 1:300 OLD POND RD STE 201
Practice Address - Street 2:
Practice Address - City:BRIDGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15017-1270
Practice Address - Country:US
Practice Address - Phone:412-220-7323
Practice Address - Fax:412-220-7325
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-31
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK001106171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAAK001106OtherDEPARTMENT OF STATE