Provider Demographics
NPI:1679643027
Name:KAN, LI (MD)
Entity Type:Individual
Prefix:DR
First Name:LI
Middle Name:
Last Name:KAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 630360
Mailing Address - Street 2:
Mailing Address - City:LITTLE NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11363-0360
Mailing Address - Country:US
Mailing Address - Phone:718-888-9443
Mailing Address - Fax:888-749-6861
Practice Address - Street 1:13620 38TH AVE STE 7B
Practice Address - Street 2:QUEENS CROSSING
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4263
Practice Address - Country:US
Practice Address - Phone:718-888-9443
Practice Address - Fax:888-749-6861
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2023102084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH74721Medicare UPIN