Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 25MA07893300 | NJ |
N | 207N00000X | Dermatologist | MD417022 | PA |
Y | 207ND0101X | MOHS-Micrographic Surgeon | 25MA07893300 | NJ |
N | 207ND0101X | MOHS-Micrographic Surgeon | MD417022 | PA |
N | 207ND0900X | Dermatopathologist | 25MA07893300 | NJ |
NPI | 1164488417 |
---|---|
Provider Name | Kehua Li |
First Address | Sewell, NJ 08080-2359 |
Second Address | Sewell, NJ 08080-2359 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2006 |
Last Update Date | 27/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1164488417 | NPI (01) | |
25MA07893300 | STATE LICENSE (01) | NJ |
H59006 | (02) | NJ |