Provider Demographics
NPI:1689886046
Name:LI, SHUREN (LAC)
Entity type:Individual
Prefix:MR
First Name:SHUREN
Middle Name:
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 1:13178 FRANCISQUITO AVE
Mailing Address - Street 2:
Mailing Address - City:BALDWIN PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91706-3706
Mailing Address - Country:US
Mailing Address - Phone:626-337-0637
Mailing Address - Fax:
Practice Address - Street 1:13178 FRANCISQUITO AVE
Practice Address - Street 2:
Practice Address - City:BALDWIN PARK
Practice Address - State:CA
Practice Address - Zip Code:91706-3706
Practice Address - Country:US
Practice Address - Phone:626-337-0637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5341171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist