Healthcare Provider Details

I. General information

NPI: 1255794442
Provider Name (Legal Business Name): LILY EMIKO FRIEDMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2016
Last Update Date: 06/22/2020
Certification Date: 06/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 52ND ST UCSF BENIOFF CHILDREN'S HOSPITAL OAKLAND
OAKLAND CA
94609-1809
US

IV. Provider business mailing address

637 59TH ST
OAKLAND CA
94609-1415
US

V. Phone/Fax

Practice location:
  • Phone: 510-428-3331
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA153441
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: