Provider Demographics
NPI:1235428038
Name:LY, TIFFANY (MD)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:LY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1300 CRANE ST
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-4260
Mailing Address - Country:US
Mailing Address - Phone:650-498-6500
Mailing Address - Fax:
Practice Address - Street 1:1300 CRANE ST
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4260
Practice Address - Country:US
Practice Address - Phone:650-498-6649
Practice Address - Fax:650-327-2241
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-01
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA123352207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine