Provider Demographics
NPI:1295978872
Name:LY, VI HUNG (DC)
Entity type:Individual
Prefix:MR
First Name:VI
Middle Name:HUNG
Last Name:LY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 E CAMERON AVE
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-3848
Mailing Address - Country:US
Mailing Address - Phone:909-908-1968
Mailing Address - Fax:
Practice Address - Street 1:1710 W CAMERON AVE STE 110
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-2720
Practice Address - Country:US
Practice Address - Phone:626-813-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-13
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-31208111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor