Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | A85786 | CA |
NPI | 1023036415 |
---|---|
Provider Name | Ly Thi Tong |
First Address | Woodland Hills, CA 91367-6701 |
Second Address | Woodland Hills, CA 91367-6701 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 15/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A857860 | (05) | CA |
I56577 | (02) | CA |