Provider Demographics
NPI:1982793733
Name:DR KEWA LI MD INC
Entity type:Organization
Organization Name:DR KEWA LI MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEWA
Authorized Official - Middle Name:
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-760-0622
Mailing Address - Street 1:PO BOX 635493
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5493
Mailing Address - Country:US
Mailing Address - Phone:614-451-8770
Mailing Address - Fax:614-451-2291
Practice Address - Street 1:2931 DONNYLANE BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-3228
Practice Address - Country:US
Practice Address - Phone:614-760-0622
Practice Address - Fax:614-760-0610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35079470207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2814413Medicaid
OHDF7242OtherRAILROAD MEDICARE
OHDF7242OtherRAILROAD MEDICARE