Provider Demographics
NPI:1356016273
Name:LY, GIANG HOANG (APRN)
Entity Type:Individual
Prefix:
First Name:GIANG
Middle Name:HOANG
Last Name:LY
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10603 BELLAIRE BLVD STE B116
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77072-5229
Mailing Address - Country:US
Mailing Address - Phone:832-328-1437
Mailing Address - Fax:
Practice Address - Street 1:10603 BELLAIRE BLVD STE B-116B
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77072-5222
Practice Address - Country:US
Practice Address - Phone:832-328-1437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-12
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1046790363LF0000X
TXAP1046790363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily