MEDICARE: DR. THANG M LY DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	50951	CA

General Provider Information

NPI Number	:	1467745836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THANG M LY DDS

Provider Business Mailing Address
First Line	:	1753 W SAN CARLOS ST
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95128-5222
Country	:	US
Telephone Number	:	408-999-0707
Fax Number	:	408-999-0135

Provider Business Practice Location Address
First Line	:	1753 W SAN CARLOS ST
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95128-5222
Country	:	US
Telephone Number	:	408-999-0707
Fax Number	:	408-999-0135

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2011
Last Update Date	:	05/18/2011

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