Healthcare Provider Details

I. General information

NPI: 1528412913
Provider Name (Legal Business Name): NAM K. LY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2016
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 KINGS HWY
BROOKLYN NY
11234-2625
US

IV. Provider business mailing address

PO BOX 28082
NEW YORK NY
10087-5024
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-6426
  • Fax: 212-876-3906
Mailing address:
  • Phone: 212-241-7473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number312405
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number312405
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: