Mai Tu Ly, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

57428 Issued in CA

Practice address

345 9TH St
Suite #302
Oakland, CA 94607-6522

Phone

(415) 269-7975

NPI assigned

Aug 6, 2008

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

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1217980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1324339200000",
    "number": "1932365111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "345 9TH ST",
            "address_2": "SUITE #302",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946076522",
            "telephone_number": "415-269-7975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "345 9TH ST",
            "address_2": "SUITE #302",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946076522",
            "telephone_number": "415-269-7975"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LY",
        "first_name": "MAI",
        "middle_name": "TU",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-08-06",
        "last_updated": "2011-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "57428",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "57428",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dat Ly, MD
• Elizabeth Ly
• Ha Ly
• Holly Ly, PHARMD
• Jimmy Ly, PHARMD
• Olivia Ly
• Phuong Ly
• Vy Kim Ly
• Timofey Lyashenko
• John Erik Lyckfors I, PHARMD D

• General Practice Dentistry in Oakland, CA
• Providers in Oakland, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2011; 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.

Verify at the official NPI Registry.