Provider Demographics
NPI:1316079114
Name:THONG, LY SANH (DC)
Entity type:Individual
Prefix:DR
First Name:LY
Middle Name:SANH
Last Name:THONG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4140 TYLER ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-3445
Mailing Address - Country:US
Mailing Address - Phone:951-688-1135
Mailing Address - Fax:951-688-0931
Practice Address - Street 1:4205 RIVIERA DR
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92883-0771
Practice Address - Country:US
Practice Address - Phone:951-340-3403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28746111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor