Provider Demographics
NPI:1326053059
Name:POON, LILLY S (MD)
Entity Type:Individual
Prefix:DR
First Name:LILLY
Middle Name:S
Last Name:POON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:950 STOCKTON STREET
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-1633
Mailing Address - Country:US
Mailing Address - Phone:415-929-0399
Mailing Address - Fax:
Practice Address - Street 1:950 STOCKTON STREET
Practice Address - Street 2:SUITE 300
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-1633
Practice Address - Country:US
Practice Address - Phone:415-929-0399
Practice Address - Fax:415-929-0399
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA18901207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A189010Medicaid
A21510Medicare UPIN