Provider Demographics
NPI:1194217224
Name:LY, DANIEL CHAN (DO)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:CHAN
Last Name:LY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:2100 MACK BLVD
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-5622
Mailing Address - Country:US
Mailing Address - Phone:484-884-0617
Mailing Address - Fax:484-884-0628
Practice Address - Street 1:1431 NURSERY ST STE 102
Practice Address - Street 2:
Practice Address - City:FOGELSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18051-1612
Practice Address - Country:US
Practice Address - Phone:610-821-4920
Practice Address - Fax:610-821-1358
Is Sole Proprietor?:No
Enumeration Date:2018-06-04
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOT018602208000000X
PAOS021279208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics