Provider Demographics
NPI:1508963273
Name:CHUNG, LILY S (MD)
Entity Type:Individual
Prefix:DR
First Name:LILY
Middle Name:S
Last Name:CHUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 11509
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92423-1509
Mailing Address - Country:US
Mailing Address - Phone:909-521-8698
Mailing Address - Fax:909-266-0055
Practice Address - Street 1:28078 BAXTER ROAD
Practice Address - Street 2:SUITE 228
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-1403
Practice Address - Country:US
Practice Address - Phone:909-521-8698
Practice Address - Fax:909-266-0055
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA786362084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11671516OtherCAQH