Provider Demographics
NPI:1467965632
Name:LY, THUY NGOC
Entity Type:Individual
Prefix:MRS
First Name:THUY
Middle Name:NGOC
Last Name:LY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 MEADOWVIEW LN
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186-3847
Mailing Address - Country:US
Mailing Address - Phone:703-627-9321
Mailing Address - Fax:
Practice Address - Street 1:186 MEADOWVIEW LN
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-3847
Practice Address - Country:US
Practice Address - Phone:703-627-9321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-09
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA984863247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other