Provider Demographics
NPI:1760115521
Name:LY, MICHELLE (PA)
Entity Type:Individual
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First Name:MICHELLE
Middle Name:
Last Name:LY
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Gender:F
Credentials:PA
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Mailing Address - Street 1:2521 GRIFFIN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-2373
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1000 SOUTH FREMONT AVENUE
Practice Address - Street 2:UNIT 7, BLDG. A10, STE. N10100
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91803
Practice Address - Country:US
Practice Address - Phone:626-457-4240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant