Provider Demographics
NPI:1962675199
Name:LY, CHING
Entity Type:Individual
Prefix:
First Name:CHING
Middle Name:
Last Name:LY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 N GARFIELD AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-7501
Mailing Address - Country:US
Mailing Address - Phone:626-782-7611
Mailing Address - Fax:626-782-7612
Practice Address - Street 1:41 N GARFIELD AVE
Practice Address - Street 2:STE 102
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-7501
Practice Address - Country:US
Practice Address - Phone:626-782-7611
Practice Address - Fax:626-782-7812
Is Sole Proprietor?:No
Enumeration Date:2008-04-09
Last Update Date:2018-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT34579225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist