Provider Demographics
NPI:1326127374
Name:LII, ANGELA DONG (MD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:DONG
Last Name:LII
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 1:723 S GARFIELD AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-4429
Mailing Address - Country:US
Mailing Address - Phone:626-289-9788
Mailing Address - Fax:
Practice Address - Street 1:723 S GARFIELD AVE STE 204
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-4429
Practice Address - Country:US
Practice Address - Phone:626-289-9788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA65035207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A650350Medicaid
CA1326127374Medicare PIN
CAA65035Medicare ID - Type UnspecifiedMEDICARE PROVIDER #
CAG82038Medicare UPIN