Provider Demographics
NPI:1518217587
Name:LY, OANH THI (DDS)
Entity Type:Individual
Prefix:
First Name:OANH
Middle Name:THI
Last Name:LY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23635 EL TORO RD
Mailing Address - Street 2:SUITE H3
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-4748
Mailing Address - Country:US
Mailing Address - Phone:949-951-4885
Mailing Address - Fax:949-951-1538
Practice Address - Street 1:23635 EL TORO RD
Practice Address - Street 2:SUITE H3
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-4748
Practice Address - Country:US
Practice Address - Phone:949-951-4885
Practice Address - Fax:949-951-1538
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA475191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice