Provider Demographics
NPI:1902979867
Name:LI, QUN (LAC)
Entity Type:Individual
Prefix:MS
First Name:QUN
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-4222
Mailing Address - Country:US
Mailing Address - Phone:925-930-5639
Mailing Address - Fax:925-930-5699
Practice Address - Street 1:1615 N BROADWAY
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-4222
Practice Address - Country:US
Practice Address - Phone:925-930-5639
Practice Address - Fax:925-930-5699
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11166171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1457431330OtherACUPUNCTURIST