Provider Demographics
NPI:1801988977
Name:BORIS, LILY HELEN (MD)
Entity type:Individual
Prefix:MS
First Name:LILY
Middle Name:HELEN
Last Name:BORIS
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:PO BOX 3228
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539
Mailing Address - Country:US
Mailing Address - Phone:510-552-1376
Mailing Address - Fax:
Practice Address - Street 1:210 EAST HACIENDA AVENUE
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008
Practice Address - Country:US
Practice Address - Phone:408-874-1823
Practice Address - Fax:408-874-1950
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA62064207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A620641Medicare PIN
00A620641Medicare Oscar/Certification
G72888Medicare UPIN