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TIFFANY TONG LY
NPI 1225884554
Physician Assistant in San Diego, CA

Active since April 26, 2024PECOS Enrolled
4060 FAIRMOUNT AVE, SAN DIEGO, CA 92105(714) 400-5093 Get Directions Write a Review

NPPES record last updated: February 9, 2026. Verified against the NPPES registry weekly; last sync: September 06, 2026.

Record update history: Feb 3, 2026, Apr 26, 2024 (2 updates tracked since 2024).

About Tiffany Tong Ly NPPES

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

TIFFANY TONG LY (NPI 1225884554) is an individual physician assistant in San Diego, California, licensed in California (PA67669) and active in the NPI registry since April 2024. She is enrolled in Medicare PECOS and is a graduate of Other (2025).

NPPES Registry Identity

NPI1225884554
Entity TypeIndividualFemale
Primary Taxonomy363A00000X
Provider Legal NameTIFFANY TONG LY
Location Address4060 FAIRMOUNT AVESan Diego, CA 92105-1608
Mailing Address6234 Osler StSan Diego, CA 92111-5408 · (714) 400-5093
Phone(714) 400-5093
Sole ProprietorNo
Medical School CMSOtherGraduated 2025
Enumeration DateApril 26, 2024
Last NPPES UpdateFebruary 9, 20262 updates tracked since enumeration
NPPES CertifiedFebruary 9, 2026
✔ NPI 1225884554 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
License✔ Licensed in CA · PA67669
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.
4060 FAIRMOUNT AVE, San Diego, CA 92105
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Tiffany Tong Ly is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID2961984075
PECOS Enrollment IDI20260306000744
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 92105 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$94.87 typical visit price
range $62.10 – $184.71
Typical copayment $23.71 (range $15.52 – $46.17)
Most-billed visit code 99203
Established Patient
$76.87 typical visit price
range $20.62 – $151.42
Typical copayment $19.21 (range $5.15 – $37.85)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. DORA DOAN O.D.
Optometrist
4060 FAIRMOUNT AVE, OPTOMETRY DEPARTMENT
SAN DIEGO, CA 92105
San Diego County (619) 961-0803
DIANA P ALVAREZ MSW
Counselor (Mental Health)
4060 FAIRMOUNT AVE
SAN DIEGO, CA 92105
San Diego County (619) 295-6047
ANTOINETTE KIM LIEU PHARMD
Pharmacist
4060 FAIRMOUNT AVE
SAN DIEGO, CA 92105
San Diego County (619) 564-7013
KALEELAH RAE, NAJA MUHAMMAD
Student in an Organized Health Care Education/Training Program
4060 FAIRMOUNT AVE
SAN DIEGO, CA 92105
San Diego County (619) 280-4213
DR. ADLA TESSIER M.D.
Internal Medicine
4060 FAIRMOUNT AVE, FAMILY PRACTICE
SAN DIEGO, CA 92105
San Diego County (619) 255-9155
CYNTHIA MIRANDA PSYD
Psychologist
4060 FAIRMOUNT AVE
SAN DIEGO, CA 92105
San Diego County (619) 564-8765
TONYA DANIELLE DANIEL LCSW
Social Worker (Clinical)
4060 FAIRMOUNT AVE
SAN DIEGO, CA 92105
San Diego County (619) 584-1612
SAMANTHA GOGGIN MD
Pediatrics
4060 FAIRMOUNT AVE, PEDIATRICS DEPARTMENT
SAN DIEGO, CA 92105
San Diego County (619) 255-9154

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 Tiffany Ly's NPI number?

The NPI number for Tiffany Ly is 1225884554. It was assigned to this individual provider in the NPPES registry on April 26, 2024.

Where is Tiffany Ly located?

Tiffany Ly practices at 4060 Fairmount Ave, San Diego, CA 92105. The listed phone number is (714) 400-5093.

What is Tiffany Ly's specialty?

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

Is Tiffany Ly enrolled in Medicare?

Yes. Tiffany Ly is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Tiffany Ly was last updated on February 9, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.