| Keith K Ly, Do, P.s. | |
|
6007 244th St Sw # B Mountlake Terrace WA 98043-5400 | |
| (425) 673-8000 | |
| (425) 673-9000 |
| Full Name | Keith K Ly, Do, P.s. |
|---|---|
| Speciality | Family Medicine |
| Location | 6007 244th St Sw # B, Mountlake Terrace, Washington |
| Authorized Official Name and Position | Keith K Ly (OWNER) |
| Authorized Official Contact | 4256738000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Keith K Ly, Do, P.s. 6007 244th St Sw # B Mountlake Terrace WA 98043-5400 Ph: (425) 673-8000 | Keith K Ly, Do, P.s. 6007 244th St Sw # B Mountlake Terrace WA 98043-5400 Ph: (425) 673-8000 |
| NPI Number | 1659579688 |
|---|---|
| Provider Enumeration Date | 07/11/2007 |
| Last Update Date | 11/14/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659579688 | NPI | - | NPPES |
| 1124254 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | OP00001670 (Washington) | Primary |
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