Active NPI
Brandon Ly, DO
- Student in an Organized Health Care Education/Training Program
- Riverside, CA
National Provider Identifier
1609653492
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- License
- 4521
- Practice address
- 4445 Magnolia Ave
Riverside, CA 92501-4135 - Phone
- (951) 788-3550
- NPI assigned
- Sep 13, 2023
- Reactivated
- Mar 27, 2025
- Last updated
- May 1, 2026
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | 4521 | CA | Primary |
Addresses
Primary practice location
4445 Magnolia Ave
Riverside, CA 92501-4135
Mailing address
4445 Magnolia Ave
Riverside, CA 92501-4199
Phone (951) 788-3000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4521 | CA | MD | Student in an Organized Health Care Education/Training Program |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1694563200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1777593600000",
"number": "1609653492",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4445 MAGNOLIA AVE",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925014199",
"telephone_number": "951-788-3000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4445 MAGNOLIA AVE",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925014135",
"telephone_number": "951-788-3550"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LY",
"first_name": "BRANDON",
"credential": "DO",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-09-13",
"last_updated": "2026-05-01",
"certification_date": "2026-05-01",
"deactivation_date": "2025-03-21",
"reactivation_date": "2025-03-27",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "CA",
"license": "4521",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Riverside, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2026; 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.