Provider Demographics
NPI:1053647537
Name:LI, JUN
Entity type:Individual
Prefix:MS
First Name:JUN
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9231 57TH AVE
Mailing Address - Street 2:6J
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-5075
Mailing Address - Country:US
Mailing Address - Phone:718-592-3903
Mailing Address - Fax:
Practice Address - Street 1:9231 57TH AVE
Practice Address - Street 2:6J
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-5075
Practice Address - Country:US
Practice Address - Phone:718-592-3903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-19
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003454171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist