MEDICARE: AN NGOC LY DMD DENTAL CORPORATION

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

General Provider Information

NPI Number	:	1528995552
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AN NGOC LY DMD DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	1125 S TORRY PL
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92806-4924
Country	:	US
Telephone Number	:	714-818-3520
Fax Number	:

Provider Business Practice Location Address
First Line	:	149 E LINCOLN AVE
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92865-1136
Country	:	US
Telephone Number	:	714-818-3520
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	AN NGOC LY
Credential	:	DMD
Telephone Number	:	714-818-3520

Provider Enumeration Date	:	05/05/2026
Last Update Date	:	05/05/2026

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