Provider Demographics
NPI:1023036415
Name:TONG, LY THI (MD)
Entity Type:Individual
Prefix:
First Name:LY
Middle Name:THI
Last Name:TONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 DE SOTO AVE
Mailing Address - Street 2:DEPARTMENT OF OPHTHALMOLOGY, 2ND FLOOR
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-6701
Mailing Address - Country:US
Mailing Address - Phone:818-719-3770
Mailing Address - Fax:
Practice Address - Street 1:5601 DE SOTO AVE
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-6701
Practice Address - Country:US
Practice Address - Phone:818-719-3770
Practice Address - Fax:818-719-2201
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA85786207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A857860Medicaid
CAI56577Medicare UPIN
CA00A857860Medicaid
CAWA85786AMedicare ID - Type UnspecifiedLOS ANGELES