Provider Demographics
NPI:1043348188
Name:LY, QUY VAN (DDS)
Entity Type:Individual
Prefix:MR
First Name:QUY
Middle Name:VAN
Last Name:LY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8481 HEIL AVE STE B
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-7848
Mailing Address - Country:US
Mailing Address - Phone:714-305-5199
Mailing Address - Fax:310-352-4030
Practice Address - Street 1:8481 HEIL AVE STE B
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-7848
Practice Address - Country:US
Practice Address - Phone:714-305-5199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA406651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice