Individual
LY KONG PHENG JALAO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2200 DEL PASO BLVD, SACRAMENTO, CA 95815-3102
(916) 642-1890
Mailing address
6817 E LANE AVE, FRESNO, CA 93727-5814
(209) 613-9089
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
NP95009751
CA
Other
Enumeration date
09/12/2018
Last updated
09/12/2018
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