Individual
MICHELLE W LY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
17772 BEACH BLVD, HUNTINGTON BEACH, CA 92647-6819
(714) 843-5011
Mailing address
PO BOX 660565, ARCADIA, CA 91066-0565
(626) 447-0296
(626) 447-6057
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
20A10691
CA
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
0036120302
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20A10691
MEDICAL LICENSE
CA
Enumeration date
04/21/2008
Last updated
11/30/2021
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