Healthcare Provider Details

I. General information

NPI: 1528995552
Provider Name (Legal Business Name): AN NGOC LY DMD DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 E LINCOLN AVE
ORANGE CA
92865-1136
US

IV. Provider business mailing address

1125 S TORRY PL
ANAHEIM CA
92806-4924
US

V. Phone/Fax

Practice location:
  • Phone: 714-818-3520
  • Fax:
Mailing address:
  • Phone: 714-818-3520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNULL

VIII. Authorized Official

Name: AN NGOC LY
Title or Position: PRESIDENT
Credential: DMD
Phone: 714-818-3520