Provider Demographics
NPI:1760719801
Name:KEHAN LI, D.D.S., INC.
Entity Type:Organization
Organization Name:KEHAN LI, D.D.S., INC.
Other - Org Name:MID-PENINSULA DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KEHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:650-922-7130
Mailing Address - Street 1:415 N SAN MATEO DR STE 1
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-2494
Mailing Address - Country:US
Mailing Address - Phone:650-401-8686
Mailing Address - Fax:650-350-3209
Practice Address - Street 1:415 N SAN MATEO DR STE 1
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-2494
Practice Address - Country:US
Practice Address - Phone:650-401-8686
Practice Address - Fax:650-350-3209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-11
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA472791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty