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General NPI Number Information
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NPI Number | 1437952967
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Entity Type | Organization
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Legal Business Name | MICHAEL M.B
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Dates
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Enumeration Date | 03/31/2025
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Last Update Date | 03/31/2025
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Provider Practice Location Address
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Address Line | 2447 W VALLEY BLVD
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City | ALHAMBRA
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State | CA
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Zip | 91803-1933
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Country | US
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Telephone | 626-300-9251
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Fax | 626-300-8911
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Provider Business Mailing Address
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Address Line | 2447 W VALLEY BLVD
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City | ALHAMBRA
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State | CA
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Zip | 91803-1933
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Country | US
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Telephone | 626-300-9251
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL MB LY
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Credential | OD
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Telephone | 626-300-9251
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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