Organization Active NPI

Advanced Dermatology, P.C.

  • Dermatology Physician
  • Sewell, NJ
National Provider Identifier
1124109913
Registry record updated Aug 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
25MA07893300 Issued in NJ
Legal business name
ADVANCED DERMATOLOGY, P.C.
Practice address
570 Egg Harbor Rd Ste C1
Sewell, NJ 08080-2359
Phone
(856) 256-8899
Fax
(856) 256-8868
NPI assigned
Oct 18, 2006
Last updated
Aug 3, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kehua Li, MDNPI 1164488417
Title
President
Phone
(856) 256-8899

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207N00000X 25MA07893300 NJ Primary
MOHS-Micrographic Surgery PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ND0101X 25MA07893300 NJ
Dermatopathology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ND0900X 25MA07893300 NJ

Addresses

Primary practice location

570 Egg Harbor Rd Ste C1
Sewell, NJ 08080-2359

Mailing address

570 Egg Harbor Rd
Suite C-1
Sewell, NJ 08080-2359
Phone (856) 256-8899

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070525000283 NJ Part B Supplier - Clinic/Group Practice 2264539204 Receives reassigned benefits from 5 practitioners
Practice locations: Sewell, NJ

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
31D1078763Advanced Dermatology, PC570 Egg Harbor Road, Sewell, NJ 08080ComplianceMay 28, 2028

National Provider Directory

National Provider Directory

Locations

501 Main St
Ste 2
Bay Saint Louis, MS 39520

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1754179200000",
    "number": "1124109913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "570 EGG HARBOR RD",
            "address_2": "SUITE C-1",
            "city": "SEWELL",
            "state": "NJ",
            "postal_code": "080802359",
            "telephone_number": "856-256-8899",
            "fax_number": "856-256-8868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "570 EGG HARBOR RD STE C1",
            "city": "SEWELL",
            "state": "NJ",
            "postal_code": "080802359",
            "telephone_number": "856-256-8899",
            "fax_number": "856-256-8868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED DERMATOLOGY, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-18",
        "last_updated": "2025-08-03",
        "certification_date": "2025-08-03",
        "status": "A",
        "authorized_official_last_name": "LI",
        "authorized_official_first_name": "KEHUA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "856-256-8899",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "NJ",
            "license": "25MA07893300",
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "NJ",
            "license": "25MA07893300",
            "primary": false
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, Dermatopathology",
            "state": "NJ",
            "license": "25MA07893300",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sewell, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.