Provider Demographics
NPI:1528279718
Name:LY, KHANH (DDS)
Entity type:Individual
Prefix:DR
First Name:KHANH
Middle Name:
Last Name:LY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9300 BURNET AVE UNIT 130
Mailing Address - Street 2:
Mailing Address - City:NORTH HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91343-7057
Mailing Address - Country:US
Mailing Address - Phone:626-758-0461
Mailing Address - Fax:
Practice Address - Street 1:3351 TYLER AVE
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-3101
Practice Address - Country:US
Practice Address - Phone:626-279-5371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46293122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist