Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 46089 | CO |
NPI | 1003067547 |
---|---|
Provider Name | Dr. Huy C Ly |
First Address | Denver, CO 80247-1314 |
Second Address | Denver, CO 80204 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2008 |
Last Update Date | 25/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
028887 | KAISER COMMERCIAL NUMBER (01) | CO |
38383586 | (05) | CO |