NPIMap

Organization Active NPI

Lilly Kao, M.D., Inc.

  • Psychiatry Physician
  • Tustin, CA
National Provider Identifier
1710271663
Registry record updated Jun 7, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
C53602 Issued in CA
Legal business name
LILLY KAO, M.D., INC.
Practice address
14351 Red Hill Ave
Suite C
Tustin, CA 92780-6271
Phone
(714) 838-5562
Fax
(714) 838-5560
NPI assigned
Jun 7, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Lori R Granese
Title
Coo
Phone
(949) 489-5564

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X C53602 CA Primary

Addresses

Primary practice location

14351 Red Hill Ave
Suite C
Tustin, CA 92780-6271

Mailing address

28 Monarch Bay PLZ
Suite N
Dana Point, CA 92629-3460
Phone (949) 489-5564

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1307404800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1307404800000",
    "number": "1710271663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28 MONARCH BAY PLZ",
            "address_2": "SUITE N",
            "city": "DANA POINT",
            "state": "CA",
            "postal_code": "926293460",
            "telephone_number": "949-489-5564",
            "fax_number": "949-493-9350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14351 RED HILL AVE",
            "address_2": "SUITE C",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927806271",
            "telephone_number": "714-838-5562",
            "fax_number": "714-838-5560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LILLY KAO, M.D., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-07",
        "last_updated": "2011-06-07",
        "status": "A",
        "authorized_official_last_name": "GRANESE",
        "authorized_official_first_name": "LORI",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "949-489-5564"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "C53602",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tustin, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.