Provider Demographics
NPI:1508830589
Name:KAO, LILLY I (MD)
Entity Type:Individual
Prefix:
First Name:LILLY
Middle Name:I
Last Name:KAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5199 E PACIFIC COAST HWY STE 330N
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-3353
Mailing Address - Country:US
Mailing Address - Phone:562-365-2020
Mailing Address - Fax:
Practice Address - Street 1:5199 E PACIFIC COAST HWY STE 330N
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-3353
Practice Address - Country:US
Practice Address - Phone:562-365-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0810572084P0800X
CAC536022084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2411983Medicaid
H87475Medicare UPIN
OH2411983Medicaid
KA4109681Medicare PIN