Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | DEN.00010294 | CO |
Y | 1223D0004X | Dentist Anesthesiologist | DEN.00010294 | CO |
NPI | 1649438292 |
---|---|
Provider Name | Dr. Quen Ly |
First Address | Aurora, CO 80045-7106 |
Second Address | Aurora, CO 80045-7106 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2008 |
Last Update Date | 19/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
23423285 | (05) | CO |