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KIM LY PA-C
NPI 1043017569
Physician Assistant in Garden Grove, CA

Active since March 03, 2025
12522 SHELLEY DR APT 6, GARDEN GROVE, CA 92840(714) 837-0386 Get Directions Write a Review

NPPES record last updated: March 3, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Kim Ly Pa-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KIM LY PA-C (NPI 1043017569) is an individual physician assistant in Garden Grove, California and active in the NPI registry since March 2025.

NPPES Registry Identity

NPI1043017569
Entity TypeIndividualFemale
Primary Taxonomy363A00000X
Provider Legal NameKIM LYCredential: PA-C
Location Address12522 SHELLEY DR APT 6Garden Grove, CA 92840-4940
Mailing Address12522 Shelley Dr Apt 6Garden Grove, CA 92840-4940 · (714) 837-0386
Phone(714) 837-0386
Sole ProprietorYes
Enumeration DateMarch 3, 2025
NPPES CertifiedMarch 3, 2025
✔ NPI 1043017569 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
Definition
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
12522 SHELLEY DR APT 6, Garden Grove, CA 92840
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Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kim Ly's NPI number?

The NPI number for Kim Ly is 1043017569. It was assigned to this individual provider in the NPPES registry on March 3, 2025.

Where is Kim Ly located?

Kim Ly practices at 12522 Shelley Dr Apt 6, Garden Grove, CA 92840. The listed phone number is (714) 837-0386.

What is Kim Ly's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

When was this NPI record last updated?

The NPPES record for Kim Ly was last updated on March 3, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.