MEDICARE: DR. PETER PHONG LY M.D.

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	208VP0014X	Interventional Pain Medicine Physician	A65780	CA
2	207L00000X	Anesthesiology Physician	A65780	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588684724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER PHONG LY M.D.

Provider Business Mailing Address
First Line	:	PO BOX 4259
Second Line	:
City	:	CERRITOS
State	:	CA
Zip	:	90703-4259
Country	:	US
Telephone Number	:	562-407-2080
Fax Number	:	562-407-2082

Provider Business Practice Location Address
First Line	:	10921 CHERRY ST STE 200
Second Line	:
City	:	LOS ALAMITOS
State	:	CA
Zip	:	90720-2473
Country	:	US
Telephone Number	:	562-407-2080
Fax Number	:	562-407-2082

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

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	09/30/2024

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Directions to “ DR. PETER PHONG LY M.D.” Practice Location

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