Provider Demographics
NPI:1255318259
Name:HUNG, LILY N (DPT MHA MCS CFCE)
Entity Type:Individual
Prefix:MRS
First Name:LILY
Middle Name:N
Last Name:HUNG
Suffix:
Gender:F
Credentials:DPT MHA MCS CFCE
Other - Prefix:MRS
Other - First Name:LILY
Other - Middle Name:N
Other - Last Name:WANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT MHA
Mailing Address - Street 1:14611 CARMENITA RD
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-5228
Mailing Address - Country:US
Mailing Address - Phone:562-600-0138
Mailing Address - Fax:888-308-0138
Practice Address - Street 1:14611 CARMENITA RD
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650
Practice Address - Country:US
Practice Address - Phone:562-600-0138
Practice Address - Fax:888-308-0138
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-30
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFY045208100000X
CAPT153682251G0304X
CAPT015368225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5662490OtherFIRST HEALTH
CA10802140OtherBLUE CROSS ADVANTAGE SENIOR PLAN
CA694030OtherUNITED HEALTH CARE
CAOPT153680OtherBLUE SHIELD