MEDICARE: DR. VINH Q LY DMD

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	22DI02724100	NJ

General Provider Information

NPI Number	:	1467939793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VINH Q LY DMD

Provider Business Mailing Address
First Line	:	2154 JOHN F KENNEDY BLVD
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07305-1614
Country	:	US
Telephone Number	:	717-826-1400
Fax Number	:

Provider Business Practice Location Address
First Line	:	3630 JOHN F KENNEDY BLVD
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07307-3204
Country	:	US
Telephone Number	:	201-222-5288
Fax Number	:

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

Provider Enumeration Date	:	07/19/2018
Last Update Date	:	07/19/2018

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