Healthcare Provider Details

I. General information

NPI: 1003067547
Provider Name (Legal Business Name): HUY C LY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2008
Last Update Date: 01/25/2022
Certification Date: 01/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W 11TH AVE APT 517
DENVER CO
80204
US

IV. Provider business mailing address

10350 E DAKOTA AVE
DENVER CO
80247-1314
US

V. Phone/Fax

Practice location:
  • Phone: 720-841-6706
  • Fax:
Mailing address:
  • Phone: 303-338-3382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number46089
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: