Active NPI
Tuan Thanh Ly, DDS
- Pediatric Dentistry
- Escondido, CA
National Provider Identifier
1639362270
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 57169
- Practice address
- 910 E Grand Ave
Suite a
Escondido, CA 92025-3430 - Phone
- (760) 745-0593
- NPI assigned
- Aug 27, 2007
- Last updated
- Feb 22, 2022
- 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 |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 57169 | CA | Primary |
Addresses
Primary practice location
910 E Grand Ave
Suite a
Escondido, CA 92025-3430
Mailing address
13242 Cortina
Tustin, CA 92782-8730
Phone (714) 504-4237
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 57169 | CA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tuan T. Ly DDS, Inc | Pediatric Dentistry | Past | Accepting new patients |
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.
-
- Pediatric Dentistry
- Escondido, CA
- NPI 1003254004
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1188172800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1645488000000",
"number": "1639362270",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13242 CORTINA",
"city": "TUSTIN",
"state": "CA",
"postal_code": "927828730",
"telephone_number": "714-504-4237"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "910 E GRAND AVE",
"address_2": "SUITE A",
"city": "ESCONDIDO",
"state": "CA",
"postal_code": "920253430",
"telephone_number": "760-745-0593"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LY",
"first_name": "TUAN",
"middle_name": "THANH",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-08-27",
"last_updated": "2022-02-22",
"certification_date": "2021-12-21",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "CA",
"license": "57169",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Escondido, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.