Healthcare Provider Details

I. General information

NPI: 1366248742
Provider Name (Legal Business Name): DENNIS TAM MINH LY NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2025
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 W BALL RD STE 4C
ANAHEIM CA
92804-5591
US

IV. Provider business mailing address

2011 HUMFORD AVE
HACIENDA HEIGHTS CA
91745-3428
US

V. Phone/Fax

Practice location:
  • Phone: 714-683-1472
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95036319
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WG0100X
TaxonomyGastroenterology Registered Nurse
License Number95137539
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: