Healthcare Provider Details

I. General information

NPI: 1003964743
Provider Name (Legal Business Name): LILLIAN G. LUM-KAKU NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1351 24TH AVE OCEAN PARK HEALTH CENTER
SAN FRANCISCO CA
94122-1616
US

IV. Provider business mailing address

1351 24TH AVE OCEAN PARK HEALTH CENTER
SAN FRANCISCO CA
94122-1616
US

V. Phone/Fax

Practice location:
  • Phone: 415-682-1975
  • Fax: 415-661-9733
Mailing address:
  • Phone: 415-682-1975
  • Fax: 415-661-9733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberRN272026
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberNPF1887
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: