Provider Demographics
NPI:1538765342
Name:LI, KEVIN HOK-LUNG
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:HOK-LUNG
Last Name:LI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 BURRS LN
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-6031
Mailing Address - Country:US
Mailing Address - Phone:631-220-1203
Mailing Address - Fax:
Practice Address - Street 1:60 BURRS LN
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-6031
Practice Address - Country:US
Practice Address - Phone:631-220-1203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04134100183500000X
NY067440183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist