Healthcare Provider Details

I. General information

NPI: 1710151626
Provider Name (Legal Business Name): DAPHNE PHUONGDUNG LY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DUNG PHUONG LY

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 11/26/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 E CENTRAL AVE STE 335
SPOKANE WA
99208-6289
US

IV. Provider business mailing address

PO BOX 31001-4114
PASADENA CA
91110-0001
US

V. Phone/Fax

Practice location:
  • Phone: 509-482-2232
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD61593101
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberA92013
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA92013
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: