Healthcare Provider Details

I. General information

NPI: 1457231417
Provider Name (Legal Business Name): XONG LY FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2025
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 E FLORIDA AVE
HEMET CA
92543-4513
US

IV. Provider business mailing address

1207 E FLORIDA AVE
HEMET CA
92543-4513
US

V. Phone/Fax

Practice location:
  • Phone: 951-925-2523
  • Fax: 951-541-9302
Mailing address:
  • Phone: 951-925-2523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number780959
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: