Provider Demographics
NPI:1003964743
Name:LUM-KAKU, LILLIAN G (NP)
Entity type:Individual
Prefix:MS
First Name:LILLIAN
Middle Name:G
Last Name:LUM-KAKU
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1351 24TH AVE
Mailing Address - Street 2:OCEAN PARK HEALTH CENTER
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-1616
Mailing Address - Country:US
Mailing Address - Phone:415-682-1975
Mailing Address - Fax:415-661-9733
Practice Address - Street 1:1351 24TH AVE
Practice Address - Street 2:OCEAN PARK HEALTH CENTER
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94122-1616
Practice Address - Country:US
Practice Address - Phone:415-682-1975
Practice Address - Fax:415-661-9733
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN272026163WP2201X
CANPF1887363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
Not Answered363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
047407OtherSFGH INTERNAL USE ONLY-COMMERCIAL NUMBER
P85317Medicare UPIN