MEDICARE: MRS. LILY N WANG HUNG DPT MHA MCS CFCE

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	FY045	CA
2	2251G0304X	Geriatric Physical Therapist	PT15368	CA
3	225100000X	Physical Therapist	PT015368	CA

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OPT153680	OTHER	CA	BLUE SHIELD
2	694030	OTHER	CA	UNITED HEALTH CARE
3	10802140	OTHER	CA	BLUE CROSS ADVANTAGE SENIOR PLAN
4	5662490	OTHER	CA	FIRST HEALTH

NPI Number	:	1255318259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LILY N WANG HUNG DPT MHA MCS CFCE

Provider Business Mailing Address
First Line	:	2001 BUTTERFIELD RD STE 1600
Second Line	:
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-1211
Country	:	US
Telephone Number	:	866-370-8206
Fax Number	:

Provider Business Practice Location Address
First Line	:	1245 MAIN ST STE 230
Second Line	:
City	:	BUDA
State	:	TX
Zip	:	78610-2269
Country	:	US
Telephone Number	:	512-400-4437
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/30/2005
Last Update Date	:	06/04/2025

1245 MAIN ST STE 300
BUDA, TX
78610-2269

Practice Phone: 512-488-3945
Practice Fax:

1245 MAIN ST STE 230
BUDA, TX
78610-2269