Provider Demographics
NPI:1710151626
Name:LY, DAPHNE PHUONGDUNG (MD)
Entity Type:Individual
Prefix:
First Name:DAPHNE
Middle Name:PHUONGDUNG
Last Name:LY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DUNG
Other - Middle Name:PHUONG
Other - Last Name:LY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5575 W LAS POSITAS BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-5802
Mailing Address - Country:US
Mailing Address - Phone:925-416-5430
Mailing Address - Fax:
Practice Address - Street 1:5575 W LAS POSITAS BLVD STE 210
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-5802
Practice Address - Country:US
Practice Address - Phone:925-416-5430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-22
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA920132086X0206X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology