Provider Demographics
NPI:1316989932
Name:NG, LYRA W (MD)
Entity type:Individual
Prefix:
First Name:LYRA
Middle Name:W
Last Name:NG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:386 GELLERT BLVD
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-2611
Mailing Address - Country:US
Mailing Address - Phone:650-761-3500
Mailing Address - Fax:650-761-3580
Practice Address - Street 1:93 SKYLINE PLZ
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-3822
Practice Address - Country:US
Practice Address - Phone:650-991-8883
Practice Address - Fax:650-758-4636
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA76998208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A769980Medicaid