Provider Demographics
NPI:1295899623
Name:HO, KELLY LY (DDS, MDS)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:LY
Last Name:HO
Suffix:
Gender:F
Credentials:DDS, MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 W COLLEGE ST STE 104
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-1650
Mailing Address - Country:US
Mailing Address - Phone:213-617-0096
Mailing Address - Fax:213-621-1642
Practice Address - Street 1:625 W COLLEGE ST STE 104
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-1650
Practice Address - Country:US
Practice Address - Phone:213-617-0096
Practice Address - Fax:213-621-1642
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA428301223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics