Provider Demographics
NPI:1902453129
Name:DU, LILLIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:LILLIAN
Middle Name:
Last Name:DU
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 1:6280 W 3RD ST APT 133
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-3177
Mailing Address - Country:US
Mailing Address - Phone:310-423-4100
Mailing Address - Fax:
Practice Address - Street 1:8730 ALDEN DRIVE
Practice Address - Street 2:ROOM E245
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048
Practice Address - Country:US
Practice Address - Phone:310-423-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-22
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA164573207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA164573OtherCALIFORNIA MEDICAL BOARD LICENSE