Provider Demographics
NPI:1356319065
Name:YUNG, LILY Y (MD)
Entity Type:Individual
Prefix:
First Name:LILY
Middle Name:Y
Last Name:YUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 W SQUANTUM ST
Mailing Address - Street 2:MANET COMMUNITY HEALTH CENTER INC
Mailing Address - City:NO QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02171-2122
Mailing Address - Country:US
Mailing Address - Phone:617-376-3000
Mailing Address - Fax:617-774-1906
Practice Address - Street 1:110 W SQUANTUM ST
Practice Address - Street 2:MANET COMMUNITY HEALTH CENTER INC
Practice Address - City:NO QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02171-2122
Practice Address - Country:US
Practice Address - Phone:617-376-3000
Practice Address - Fax:617-774-1906
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA205539207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H18801Medicare UPIN
A31229Medicare ID - Type Unspecified