Provider Demographics
NPI:1770974941
Name:LI, CAMERON XUN (LAC)
Entity type:Individual
Prefix:MR
First Name:CAMERON
Middle Name:XUN
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 1:17226 SE GRANT ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97233-4465
Mailing Address - Country:US
Mailing Address - Phone:971-218-0387
Mailing Address - Fax:
Practice Address - Street 1:2651 COMMERCIAL ST SE STE 1
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4872
Practice Address - Country:US
Practice Address - Phone:503-587-9937
Practice Address - Fax:503-994-8049
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-10
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC170890171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist