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General NPI Number Information
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NPI Number | 1356728281
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Entity Type | Organization
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Legal Business Name | TUAN T. LY, DDS INC
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Dates
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Enumeration Date | 04/29/2015
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Last Update Date | 04/29/2015
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Provider Practice Location Address
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Address Line | 2097 COMPTON AVE SUITE 104B
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City | CORONA
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State | CA
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Zip | 92881-7282
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Country | US
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Telephone | 951-273-9992
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Fax | 951-273-9991
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Provider Business Mailing Address
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Address Line | 2097 COMPTON AVE SUITE 104B
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City | CORONA
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State | CA
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Zip | 92881-7282
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Country | US
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Telephone | 951-273-9992
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Fax | 951-273-9991
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Authorized Official
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Title or Position | PRACTICE OWNER
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Name | DR. TUAN THANH LY
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Credential | DDS
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Telephone | 951-273-9992
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 57169
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License Number State | CA
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