Provider Demographics
NPI:1952123648
Name:DUONG, LILI (PA-C)
Entity type:Individual
Prefix:
First Name:LILI
Middle Name:
Last Name:DUONG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12660 IVANHOE RD
Mailing Address - Street 2:
Mailing Address - City:LUCERNE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92356-8292
Mailing Address - Country:US
Mailing Address - Phone:760-987-4936
Mailing Address - Fax:
Practice Address - Street 1:6101 FAIR OAKS BLVD
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-4895
Practice Address - Country:US
Practice Address - Phone:916-296-0561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-25
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant