Provider Demographics
NPI:1386762532
Name:LI, JENNY SHAW (LAC, PHD)
Entity type:Individual
Prefix:DR
First Name:JENNY
Middle Name:SHAW
Last Name:LI
Suffix:
Gender:F
Credentials:LAC, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 DARCY PKWY
Mailing Address - Street 2:
Mailing Address - City:LATHROP
Mailing Address - State:CA
Mailing Address - Zip Code:95330-9222
Mailing Address - Country:US
Mailing Address - Phone:209-858-5832
Mailing Address - Fax:
Practice Address - Street 1:177 DARCY PKWY
Practice Address - Street 2:
Practice Address - City:LATHROP
Practice Address - State:CA
Practice Address - Zip Code:95330-9222
Practice Address - Country:US
Practice Address - Phone:209-858-5832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC9158171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist