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General NPI Number Information
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NPI Number | 1528279718
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Entity Type | Individual
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Provider Name | KHANH LY DDS
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Gender | Female
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Dates
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Enumeration Date | 05/27/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3351 TYLER AVE
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City | EL MONTE
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State | CA
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Zip | 91731-3101
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Country | US
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Telephone | 626-279-5371
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Fax |
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Provider Business Mailing Address
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Address Line | 9300 BURNET AVE UNIT 130
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City | NORTH HILLS
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State | CA
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Zip | 91343-7057
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Country | US
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Telephone | 626-758-0461
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 46293
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License Number State | CA
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