Man Kellie Ly, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

95032279 Issued in CA

Practice address

3106 W Beverly Blvd
Montebello, CA 90640-2217

Phone

(323) 728-1274

NPI assigned

Jul 19, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1500422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727740800000",
    "number": "1508389701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 W VALLEY VIEW DR",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928354077",
            "telephone_number": "626-390-2908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3106 W BEVERLY BLVD",
            "city": "MONTEBELLO",
            "state": "CA",
            "postal_code": "906402217",
            "telephone_number": "323-728-1274"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1817 W Beverly Blvd",
            "address_purpose": "LOCATION",
            "city": "Montebello",
            "state": "CA",
            "postal_code": "906403969",
            "country_code": "US",
            "telephone_number": "323-721-5524",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LY",
        "first_name": "MAN",
        "middle_name": "KELLIE",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-07-19",
        "last_updated": "2024-10-01",
        "certification_date": "2024-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP2201X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Ambulatory Care",
            "state": "CA",
            "license": "615128",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95032279",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Nguyen Luu
• Luxottica of America Inc
• Luxottica of America Inc.
• Luxottica Retail North America Inc
• Jasmine Ly
• Melissa Ann Ly, RPH
• M & E Consulting, Inc.
• M Voloshin DDS Professional Dental Corporation
• M.G.a. Home Health Services Inc.
• Jackson Ma, M.D.

• Family Nurse Practitioner in Montebello, CA
• Providers in Montebello, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.