Provider Demographics
NPI:1245653054
Name:LI, JACK WING KIT (DO)
Entity type:Individual
Prefix:DR
First Name:JACK
Middle Name:WING KIT
Last Name:LI
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:9120 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11416-1527
Mailing Address - Country:US
Mailing Address - Phone:718-641-8207
Mailing Address - Fax:718-848-9452
Practice Address - Street 1:9120 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11416-1527
Practice Address - Country:US
Practice Address - Phone:718-641-8207
Practice Address - Fax:718-848-9452
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-29
Last Update Date:2021-01-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY273583-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine