Provider Demographics
NPI:1497251052
Name:DINH, KELLY LY (BSN RN)
Entity Type:Individual
Prefix:MISS
First Name:KELLY
Middle Name:LY
Last Name:DINH
Suffix:
Gender:F
Credentials:BSN RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9862 CHAPMAN AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92841-2726
Mailing Address - Country:US
Mailing Address - Phone:714-620-7070
Mailing Address - Fax:
Practice Address - Street 1:9862 CHAPMAN AVE.
Practice Address - Street 2:SUITE B
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92841
Practice Address - Country:US
Practice Address - Phone:714-620-7070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95137856163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management