Healthcare Provider Details

I. General information

NPI: 1003709213
Provider Name (Legal Business Name): BAIHE LILY CUI
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2025
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 RIVER ST
WALTHAM MA
02453-5476
US

IV. Provider business mailing address

431 RIVER ST
WALTHAM MA
02453-5476
US

V. Phone/Fax

Practice location:
  • Phone: 781-966-5668
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: