Provider Demographics
NPI:1255362406
Name:LYG, A PROFESSIONAL MEDICAL CORPORATION
Entity type:Organization
Organization Name:LYG, A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LINCOLN
Authorized Official - Middle Name:S
Authorized Official - Last Name:YEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-718-9292
Mailing Address - Street 1:1401 AVOCADO AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7710
Mailing Address - Country:US
Mailing Address - Phone:949-718-9292
Mailing Address - Fax:949-718-9293
Practice Address - Street 1:1401 AVOCADO AVE STE 105
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7710
Practice Address - Country:US
Practice Address - Phone:949-718-9292
Practice Address - Fax:949-718-9293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG048746207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW22104OtherMEDICARE IDENTIFICATION NUMBER
CA00G487460Medicaid
CAE02682Medicare UPIN