Healthcare Provider Details

I. General information

NPI: 1730345299
Provider Name (Legal Business Name): LILLIAN KOE M,D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MA KHIN TINT M.D.

II. Dates (important events)

Enumeration Date: 08/04/2008
Last Update Date: 04/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 GARFIELD AVE
BELL GARDENS CA
90201-1805
US

IV. Provider business mailing address

12584 CENTRAL AVE
CHINO CA
91710-3507
US

V. Phone/Fax

Practice location:
  • Phone: 562-928-9600
  • Fax:
Mailing address:
  • Phone: 909-287-1800
  • Fax: 909-287-3300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA104910
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: