Healthcare Provider Details

I. General information

NPI: 1780101469
Provider Name (Legal Business Name): PHUNG KIM LY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2017
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 W DUARTE RD STE 102
ARCADIA CA
91007-9221
US

IV. Provider business mailing address

88 S MARENGO AVE UNIT C
ALHAMBRA CA
91801-1950
US

V. Phone/Fax

Practice location:
  • Phone: 626-317-5001
  • Fax:
Mailing address:
  • Phone: 571-232-9363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number74397
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: