Active NPI
Linda Ly
- General Practice Dentistry
- San Jose, CA
National Provider Identifier
1245419316
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 56060
- Practice address
- 55 E Julian St
San Jose, CA 95112-4007 - Phone
- (408) 918-2618
- NPI assigned
- Oct 25, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 56060 | CA | Primary |
Addresses
Primary practice location
55 E Julian St
San Jose, CA 95112-4007
Mailing address
5261 Arezzo Dr
San Jose, CA 95138-2204
Phone (408) 705-6024
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160308002113 | CA | Order and Referring Only - Other (Non-Physician) | 2860798477 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1193270400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1322006400000",
"number": "1245419316",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5261 AREZZO DR",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951382204",
"telephone_number": "408-705-6024"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "55 E JULIAN ST",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951124007",
"telephone_number": "408-918-2618"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LY",
"first_name": "LINDA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-10-25",
"last_updated": "2011-11-23",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "56060",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Jose, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.