Provider Demographics
NPI:1174716617
Name:CHAN, LILLY Y (LIC AC)
Entity type:Individual
Prefix:
First Name:LILLY
Middle Name:Y
Last Name:CHAN
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:107 E WILLOWICK AVE
Mailing Address - Street 2:APT. # 16
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-3874
Mailing Address - Country:US
Mailing Address - Phone:281-992-2888
Mailing Address - Fax:281-992-2887
Practice Address - Street 1:301 W EDGEWOOD DR STE 14
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-4400
Practice Address - Country:US
Practice Address - Phone:281-992-2888
Practice Address - Fax:281-992-2887
Is Sole Proprietor?:No
Enumeration Date:2007-08-18
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA219279171100000X
TXAC#00689171100000X
CAAC8776171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist