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General NPI Number Information
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NPI Number | 1659579688
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Entity Type | Organization
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Legal Business Name | KEITH K LY, DO, P.S.
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Dates
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Enumeration Date | 07/11/2007
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Last Update Date | 11/14/2007
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Provider Practice Location Address
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Address Line | 6007 244TH ST SW # B
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City | MOUNTLAKE TERRACE
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State | WA
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Zip | 98043-5400
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Country | US
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Telephone | 425-673-8000
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Fax | 425-673-9000
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Provider Business Mailing Address
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Address Line | 6007 244TH ST SW # B
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City | MOUNTLAKE TERRACE
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State | WA
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Zip | 98043-5400
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Country | US
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Telephone | 425-673-8000
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Fax | 425-673-9000
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Authorized Official
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Title or Position | OWNER
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Name | DR. KEITH K LY
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Credential | DO
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Telephone | 425-673-8000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OP00001670
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License Number State | WA
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