Provider Demographics
NPI:1730345299
Name:KOE, LILLIAN (M,D)
Entity type:Individual
Prefix:
First Name:LILLIAN
Middle Name:
Last Name:KOE
Suffix:
Gender:F
Credentials:M,D
Other - Prefix:
Other - First Name:MA
Other - Middle Name:KHIN
Other - Last Name:TINT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:12584 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-3507
Mailing Address - Country:US
Mailing Address - Phone:909-287-1800
Mailing Address - Fax:909-287-3300
Practice Address - Street 1:6501 GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:BELL GARDENS
Practice Address - State:CA
Practice Address - Zip Code:90201-1805
Practice Address - Country:US
Practice Address - Phone:562-928-9600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA104910208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics