Healthcare Provider Details

I. General information

NPI: 1598167298
Provider Name (Legal Business Name): LILY EGHDAMI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2014
Last Update Date: 02/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2775 LAUREL STREET 6TH FLOOR ROOM 6206
VANCOUVER BC
V5Z 1M9
CA

IV. Provider business mailing address

2775 LAUREL STREET 6TH FLOOR ROOM 6206
VANCOUVER BC
V5Z 1M9
CA

V. Phone/Fax

Practice location:
  • Phone: 604-875-4111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number27757
License Number StateZZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: