Provider Demographics
NPI:1326481771
Name:MALANG, LENNIE LYNN PEREZ (MD)
Entity Type:Individual
Prefix:DR
First Name:LENNIE LYNN
Middle Name:PEREZ
Last Name:MALANG
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 1:1730 S JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98465-1322
Mailing Address - Country:US
Mailing Address - Phone:253-227-9362
Mailing Address - Fax:
Practice Address - Street 1:11307 BRIDGEPORT WAY SW STE 200
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-3024
Practice Address - Country:US
Practice Address - Phone:253-985-6688
Practice Address - Fax:253-985-2999
Is Sole Proprietor?:No
Enumeration Date:2013-04-15
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WAMD60644302208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program