Provider Demographics
NPI:1306588165
Name:LI, BOHAN (DPM)
Entity type:Individual
Prefix:DR
First Name:BOHAN
Middle Name:
Last Name:LI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 ONEIDA AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11720-1129
Mailing Address - Country:US
Mailing Address - Phone:646-215-1282
Mailing Address - Fax:
Practice Address - Street 1:1231 DEER PARK AVE
Practice Address - Street 2:
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703-3104
Practice Address - Country:US
Practice Address - Phone:631-376-4163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-12
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
211D00000X, 390200000X
NY007465213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No211D00000XPodiatric Medicine & Surgery Service ProvidersAssistant, Podiatric
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program