Provider Demographics
NPI:1164488417
Name:LI, KEHUA (MD)
Entity type:Individual
Prefix:
First Name:KEHUA
Middle Name:
Last Name:LI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:570 EGG HARBOR RD
Mailing Address - Street 2:SUITE C-1
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-2359
Mailing Address - Country:US
Mailing Address - Phone:856-256-8899
Mailing Address - Fax:856-256-8868
Practice Address - Street 1:570 EGG HARBOR RD
Practice Address - Street 2:SUITE C-1
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-2359
Practice Address - Country:US
Practice Address - Phone:856-256-8899
Practice Address - Fax:856-256-8868
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD417022207N00000X, 207ND0101X
NJ25MA07893300207N00000X, 207ND0900X, 207ND0101X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1164488417OtherNPI
NJ25MA07893300OtherSTATE LICENSE