Provider Demographics
NPI:1699933598
Name:LI, DAN
Entity type:Individual
Prefix:MS
First Name:DAN
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 1:3530 73RD ST
Mailing Address - Street 2:#1B
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-4150
Mailing Address - Country:US
Mailing Address - Phone:718-335-7148
Mailing Address - Fax:
Practice Address - Street 1:14030 SANFORD AVE
Practice Address - Street 2:#1A
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-2567
Practice Address - Country:US
Practice Address - Phone:718-886-6989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-28
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000601171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist