Provider Demographics
NPI:1730113820
Name:LY, NGOC PHUONG (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:NGOC
Middle Name:PHUONG
Last Name:LY
Suffix:
Gender:F
Credentials:MD, MPH
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Mailing Address - Street 1:521 PARNASSUS AVE
Mailing Address - Street 2:C-344
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-2206
Mailing Address - Country:US
Mailing Address - Phone:415-476-4979
Mailing Address - Fax:415-476-9278
Practice Address - Street 1:400 PARNASSUS AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2202
Practice Address - Country:US
Practice Address - Phone:415-353-2559
Practice Address - Fax:415-353-2466
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2013-09-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA1006972080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA469767OtherTUFS HEALTH PLAN
MAJ27996OtherBCBS MA
MA2079976Medicaid
MA469767OtherTUFS HEALTH PLAN
MAJ27996OtherBCBS MA