# LILLY WILEN M.D. A MEDICAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** New Concepts Medical Group
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619028008
- **Authorized official:** LILLY WILEN M.D. (OWNER)
- **Authorized official phone:** (818) 831-3227

## Contact information

- **Practice address:** 17075 DEVONSHIRE ST, SUITE 306, NORTHRIDGE, CA 91325-1600
- **Practice address phone:** (818) 831-3228
- **Practice address fax:** (818) 831-3447
- **Mailing address:** 17075 DEVONSHIRE ST, SUITE 306, NORTHRIDGE, CA 91325-1600
- **Mailing address phone:** (818) 831-3227
- **Mailing address fax:** (818) 831-3447

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | A61876 | CA | Yes |

## Other

- **Enumeration date:** 01/15/2007
- **Last updated:** 01/05/2012