Provider Demographics
NPI:1285720342
Name:NGUYEN, LILY KHANH-LINH THI (MD)
Entity type:Individual
Prefix:
First Name:LILY
Middle Name:KHANH-LINH THI
Last Name:NGUYEN
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 1:39260 CANYON HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539
Mailing Address - Country:US
Mailing Address - Phone:510-794-8466
Mailing Address - Fax:
Practice Address - Street 1:500 W TULLY RD
Practice Address - Street 2:OB/GYN CLINIC
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95111
Practice Address - Country:US
Practice Address - Phone:408-885-5553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG78516207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G785160Medicaid
CA00G785160Medicare ID - Type Unspecified
CA00G785160Medicaid