KIM M LY
NPI 1306417860
Dentist - General Practice in Los Angeles, CA

Q: What is Kim Ly's NPI number?

The NPI number for Kim Ly is 1306417860. It was assigned to this individual provider in the NPPES registry on July 6, 2021.

Q: What is Kim Ly's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

Q: When was this NPI record last updated?

The NPPES record for Kim Ly was last updated on July 6, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years 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.

Active since July 06, 2021PECOS Enrolled

5015 WHITTIER BLVD, LOS ANGELES, CA 90022(323) 268-9191 Get Directions Write a Review

NPPES record last updated: July 6, 2021. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Kim M Ly NPPES

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

KIM M LY (NPI 1306417860) is an individual general practice provider in Los Angeles, California, licensed in California (106485) and active in the NPI registry since July 2021. She is enrolled in Medicare PECOS and is a graduate of Other (2021).

NPPES Registry Identity

NPI1306417860

Entity TypeIndividualFemale

Primary Taxonomy1223G0001X

Provider Legal NameKIM M LY

Location Address5015 WHITTIER BLVDLos Angeles, CA 90022-3116

Mailing Address800 S Harvard Blvd Apt 309Los Angeles, CA 90005-4261 · (408) 717-0496

Phone(323) 268-9191

Sole ProprietorNo

Medical School CMSOtherGraduated 2021

Enumeration DateJuly 6, 2021

NPPES CertifiedJuly 6, 2021

✔ NPI 1306417860 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers

Taxonomy Code1223G0001X

License✔ Licensed in CA · 106485

Definition

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

5015 WHITTIER BLVD, Los Angeles, CA 90022

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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)

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

PECOS PAC ID4284137571

PECOS Enrollment IDI20250912000184

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 90022 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

$96.36 typical visit price

range $62.96 – $187.60

Typical copayment $24.09 (range $15.74 – $46.90)

Most-billed visit code 99203

Established Patient

$77.96 typical visit price

range $20.84 – $153.61

Typical copayment $19.49 (range $5.21 – $38.40)

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 9

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

TERESA SIFUENTES ORTIZ FNP

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