Healthcare Provider Details

I. General information

NPI: 1164227559
Provider Name (Legal Business Name): LY MEDICAL DIAGNOSTICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2025
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13621 ROOSEVELT AVE
FLUSHING NY
11354-5655
US

IV. Provider business mailing address

6910 174TH ST
FRESH MEADOWS NY
11365-3411
US

V. Phone/Fax

Practice location:
  • Phone: 929-928-8689
  • Fax:
Mailing address:
  • Phone: 718-888-1117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: LOK YUNG
Title or Position: EMPLOYEE
Credential: MD
Phone: 718-888-1117