Active NPI
Jimmy Ly, PHARMD
- Pharmacist
- Oakland, CA
National Provider Identifier
1467061630
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 82639
- Practice address
- 3801 Howe St # G25
Oakland, CA 94611-5312 - Phone
- (510) 752-7130
- NPI assigned
- Jul 23, 2020
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 82639 | CA | Primary |
Addresses
Primary practice location
3801 Howe St # G25
Oakland, CA 94611-5312
Mailing address
3801 Howe St # G25
Oakland, CA 94611-5312
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq | Health Information Exchange (HIE) |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 82639 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1595462400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1640736000000",
"number": "1467061630",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3801 HOWE ST # G25",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946115312"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3801 HOWE ST # G25",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946115312",
"telephone_number": "510-752-7130"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LY",
"first_name": "JIMMY",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-07-23",
"last_updated": "2021-12-29",
"certification_date": "2021-12-29",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "82639",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "SOAP",
"endpointTypeDescription": "SOAP URL",
"endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
"affiliation": "N",
"endpointDescription": "Carequality",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "C-CDA",
"address_1": "3801 Howe St # G25",
"city": "Oakland",
"state": "CA",
"country_code": "US",
"postal_code": "946115312",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Oakland, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.