Individual provider Active NPI

Dennis Tam Minh Ly, NP

  • Psychiatric/Mental Health Nurse Practitioner
  • Anaheim, CA
National Provider Identifier
1366248742
Registry record updated Jan 22, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
95036319 Issued in CA
Practice address
1720 W Ball Rd Ste 4C
Anaheim, CA 92804-5591
Phone
(714) 683-1472
NPI assigned
Feb 25, 2025
Last updated
Jan 22, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 95036319 CA Primary

Addresses

Primary practice location

1720 W Ball Rd Ste 4C
Anaheim, CA 92804-5591

Mailing address

2011 Humford Ave
Hacienda Heights, CA 91745-3428

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: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251008003518 CA Practitioner - Nurse Practitioner 8325545023 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Coast Medical P CGroup PAC ID 2062951205, 8 clinicians

Practice addresses (Care Compare)

1720 W Ball Rd
Suite 4C
Anaheim, CA 92804-5591
Phone (714) 683-1472

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
95036319CAMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Coast Medical, PC Psychiatric/Mental Health CurrentSince Sep 1, 2025 Accepting new patients

Locations

1720 W Ball Rd
Ste 4C
Anaheim, CA 92804
Phone (714) 683-1472

532 N Magnolia Ave
Anaheim, CA 92801
Phone (408) 475-4446

5871 Pine Ave
Ste 120
Chino Hills, CA 91709
Phone (714) 683-1472

1800 Wilshire Blvd
Los Angeles, CA 90057
Phone (213) 478-0460

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1740441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1769040000000",
    "number": "1366248742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2011 HUMFORD AVE",
            "city": "HACIENDA HEIGHTS",
            "state": "CA",
            "postal_code": "917453428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1720 W BALL RD STE 4C",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928045591",
            "telephone_number": "714-683-1472"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LY",
        "first_name": "DENNIS",
        "middle_name": "TAM MINH",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-02-25",
        "last_updated": "2026-01-22",
        "certification_date": "2026-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95036319",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Anaheim, CA

Sources for this page

Verify at the official NPI Registry.