Provider Demographics
NPI:1083879134
Name:LI, JIA (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:JIA
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 CAMPBELL AVE # 111D
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-2770
Mailing Address - Country:US
Mailing Address - Phone:203-937-3421
Mailing Address - Fax:203-937-3803
Practice Address - Street 1:950 CAMPBELL AVE # 111D
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-2770
Practice Address - Country:US
Practice Address - Phone:203-937-3421
Practice Address - Fax:203-937-3803
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY257431207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology