Provider Demographics
NPI:1306199732
Name:BURKE, LILLIAN Y (RDHAP)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:Y
Last Name:BURKE
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:LILLIAN
Other - Middle Name:Y
Other - Last Name:HUI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2175
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-2175
Mailing Address - Country:US
Mailing Address - Phone:707-931-8994
Mailing Address - Fax:
Practice Address - Street 1:273 E WATMAUGH RD
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-7933
Practice Address - Country:US
Practice Address - Phone:707-931-8994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-23
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHAP435124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist