Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | G85643 | CA |
NPI | 1225081441 |
---|---|
Provider Name | Dr. James Lilja |
First Address | Los Gatos, CA 95032-1551 |
Second Address | Los Gatos, CA 95032-1551 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2006 |
Last Update Date | 21/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H18658 | (02) |