Basic Information
| Provider Information | |||||||||
| NPI: | 1578997581 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAO | ||||||||
| FirstName: | LIFANG | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5486 | ||||||||
| Address2: | |||||||||
| City: | ORANGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928635486 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8185500900 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 NICOLLS RD | ||||||||
| Address2: | |||||||||
| City: | STONY BROOK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117941216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314442976 | ||||||||
| FaxNumber: | 6316381199 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2013 | ||||||||
| LastUpdateDate: | 05/19/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | A132423 | CA | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 278320 | NY | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.