Basic Information
| Provider Information | |||||||||
| NPI: | 1003077074 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NGO | ||||||||
| FirstName: | LY | ||||||||
| MiddleName: | THIEN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 909 WALNUT STREET | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191075509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159551234 | ||||||||
| FaxNumber: | 2159236792 | ||||||||
| Practice Location | |||||||||
| Address1: | 909 WALNUT STREET | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191075509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159551234 | ||||||||
| FaxNumber: | 2159236792 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2008 | ||||||||
| LastUpdateDate: | 12/15/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | MD445016 | PA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084N0400X | 25MA09265000 | NJ | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
No ID Information.