Provider Demographics
NPI:1275553679
Name:WILEN, LILLY LIPING (MD)
Entity Type:Individual
Prefix:
First Name:LILLY
Middle Name:LIPING
Last Name:WILEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17075 DEVONSHIRE ST STE 306
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-5417
Mailing Address - Country:US
Mailing Address - Phone:818-831-3227
Mailing Address - Fax:
Practice Address - Street 1:17075 DEVONSHIRE ST STE 306
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-5417
Practice Address - Country:US
Practice Address - Phone:818-831-3227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61876207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A618761Medicaid
CAA61876FMedicare ID - Type Unspecified
CA00A618761Medicaid