Provider Demographics
NPI:1881664092
Name:KY, WILLY (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLY
Middle Name:
Last Name:KY
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 1:135-27 38TH AVENUE
Mailing Address - Street 2:UNIT 398
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354
Mailing Address - Country:US
Mailing Address - Phone:718-939-2020
Mailing Address - Fax:718-939-8080
Practice Address - Street 1:135-27 38TH AVENUE
Practice Address - Street 2:UNIT 398
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354
Practice Address - Country:US
Practice Address - Phone:718-939-2020
Practice Address - Fax:718-939-8080
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY201696207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
41Z811Medicare ID - Type Unspecified
H02013Medicare UPIN