Provider Demographics
NPI:1679547525
Name:LY, HUY THANHTUAN (MD)
Entity Type:Individual
Prefix:
First Name:HUY
Middle Name:THANHTUAN
Last Name:LY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 S RAINBOW BLVD
Mailing Address - Street 2:SOUND PHYSICIANS
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128
Mailing Address - Country:US
Mailing Address - Phone:702-305-2408
Mailing Address - Fax:702-853-3245
Practice Address - Street 1:5400 S RAINBOW BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-1859
Practice Address - Country:US
Practice Address - Phone:702-305-2408
Practice Address - Fax:702-853-3245
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11113207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100504231Medicaid
NV100504231Medicaid
NV101792Medicare PIN