Provider Demographics
NPI:1366530875
Name:LYONGA, DORIS E (MD)
Entity type:Individual
Prefix:
First Name:DORIS
Middle Name:E
Last Name:LYONGA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:575 EAST HARDY STREET
Mailing Address - Street 2:SUITE 104
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-4052
Mailing Address - Country:US
Mailing Address - Phone:310-673-9604
Mailing Address - Fax:310-673-3058
Practice Address - Street 1:575 EAST HARDY STREET
Practice Address - Street 2:SUITE 104
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-4038
Practice Address - Country:US
Practice Address - Phone:310-673-9604
Practice Address - Fax:310-673-3058
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2014-05-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG32526207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G325260Medicaid
CA953759719OtherTAX ID
CA00G325260Medicaid
G32526Medicare ID - Type Unspecified