Provider Demographics
NPI:1659109064
Name:LI, JAAN (PHD)
Entity type:Individual
Prefix:DR
First Name:JAAN
Middle Name:
Last Name:LI
Suffix:
Gender:U
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2093 PHILADELPHIA PIKE # 1764
Mailing Address - Street 2:
Mailing Address - City:CLAYMONT
Mailing Address - State:DE
Mailing Address - Zip Code:19703-2424
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2093 PHILADELPHIA PIKE # 1764
Practice Address - Street 2:
Practice Address - City:CLAYMONT
Practice Address - State:DE
Practice Address - Zip Code:19703-2424
Practice Address - Country:US
Practice Address - Phone:203-998-5538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171R00000X, 172V00000X, 1744R1103X, 246Z00000X, 247000000X, 372600000X
NY0000000000374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No171R00000XOther Service ProvidersInterpreter
No172V00000XOther Service ProvidersCommunity Health Worker
No1744R1103XOther Service ProvidersSpecialistResearch Data Abstracter/Coder
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
No247000000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health Information
No372600000XNursing Service Related ProvidersAdult Companion