Provider Demographics
NPI:1679771117
Name:CHAN, LILLIENNE YOON (MD)
Entity Type:Individual
Prefix:
First Name:LILLIENNE
Middle Name:YOON
Last Name:CHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LILLIENNE
Other - Middle Name:UJEE
Other - Last Name:YOON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7777 FOREST LN STE B304
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-6818
Mailing Address - Country:US
Mailing Address - Phone:972-566-8844
Mailing Address - Fax:
Practice Address - Street 1:7777 FOREST LN STE B304
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-6818
Practice Address - Country:US
Practice Address - Phone:972-566-8844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXN34012080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program