MEDICARE: PASADYNE LY

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	DDS110829	CA

General Provider Information

NPI Number	:	1750870366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PASADYNE LY

Provider Business Mailing Address
First Line	:	PO BOX 102
Second Line	:
City	:	MONTEBELLO
State	:	CA
Zip	:	90640-0102
Country	:	US
Telephone Number	:	323-837-9863
Fax Number	:

Provider Business Practice Location Address
First Line	:	12215 TELEGRAPH RD STE 111
Second Line	:
City	:	SANTA FE SPRINGS
State	:	CA
Zip	:	90670-3344
Country	:	US
Telephone Number	:	562-252-8500
Fax Number	:

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

Provider Enumeration Date	:	05/09/2018
Last Update Date	:	01/10/2026

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Directions to “ PASADYNE LY ” Practice Location

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