Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

BENJAMIN QUOC LY DO
NPI 1639963069
Student in an Organized Health Care Education/Training Program in Grand Rapids, MI

Q: What is Benjamin Ly's NPI number?

The NPI number for Benjamin Ly is 1639963069. It was assigned to this individual provider in the NPPES registry on April 9, 2025.

Q: What is Benjamin Ly's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Q: When was this NPI record last updated?

The NPPES record for Benjamin Ly was last updated on September 2, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 days 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 April 09, 2025PECOS Enrolled

300 LAFAYETTE AVE SE, GRAND RAPIDS, MI 49503(616) 685-6922(616) 685-5192 Get Directions Write a Review

NPPES record last updated: September 2, 2026. Verified against the NPPES registry weekly; last sync: September 06, 2026.

Record update history: Sep 2, 2026, Apr 9, 2025 (2 updates tracked since 2025).

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About Benjamin Quoc Ly Do NPPES

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

BENJAMIN QUOC LY DO (NPI 1639963069) is an individual student in an organized health care education/training program in Grand Rapids, Michigan and active in the NPI registry since April 2025. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1639963069

Entity TypeIndividualMale

Primary Taxonomy390200000X

Provider Legal NameBENJAMIN QUOC LYCredential: DO

Location Address300 LAFAYETTE AVE SEGrand Rapids, MI 49503-4692

Mailing Address300 Lafayette Ave SeGrand Rapids, MI 49503-4692 · (616) 685-6922 · Fax (616) 685-5192

Phone(616) 685-6922

Fax(616) 685-5192

Sole ProprietorNo

Enumeration DateApril 9, 2025

Last NPPES UpdateSeptember 2, 20262 updates tracked since enumeration

NPPES CertifiedSeptember 2, 2026

✔ NPI 1639963069 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care

Taxonomy Code390200000X

Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

300 LAFAYETTE AVE SE, Grand Rapids, MI 49503

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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)

Benjamin Quoc Ly Do is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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.

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.

DESMOND JAVON HARDEN MD

Internal Medicine

300 LAFAYETTE AVE SE
GRAND RAPIDS, MI 49503

Kent County (616) 685-6919

IBRAHIM RAZA MD

Internal Medicine

300 LAFAYETTE AVE SE, SUITE 3000
GRAND RAPIDS, MI 49503

Kent County (616) 685-4615

ALLISON WILLETT RDN

Dietitian, Registered

300 LAFAYETTE AVE SE
GRAND RAPIDS, MI 49503

Kent County (616) 685-5003

SHRUTI JAVALI

Family Medicine

300 LAFAYETTE AVE SE
GRAND RAPIDS, MI 49503

Kent County (616) 685-6922

JOHN CAVACECE DO

Family Medicine

300 LAFAYETTE AVE SE, SUITE 4200
GRAND RAPIDS, MI 49503

Kent County (616) 685-6922

RUGGERO BATTAN MD

Internal Medicine (Endocrinology, Diabetes & Metabolism)

300 LAFAYETTE AVE SE, STE 2045
GRAND RAPIDS, MI 49503

Kent County (616) 685-8760

MAHA AYASHI MD

Family Medicine

300 LAFAYETTE AVE SE, STE 4000
GRAND RAPIDS, MI 49503

Kent County (616) 685-6922

JOHN VANSCHAGEN MD

Family Medicine

300 LAFAYETTE AVE SE, SUITE 4200
GRAND RAPIDS, MI 49503

Kent County (616) 685-6922

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 Benjamin Ly's NPI number?

The NPI number for Benjamin Ly is 1639963069. It was assigned to this individual provider in the NPPES registry on April 9, 2025.

Where is Benjamin Ly located?

Benjamin Ly practices at 300 Lafayette Ave SE, Grand Rapids, MI 49503. The listed phone number is (616) 685-6922.

What is Benjamin Ly's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Benjamin Ly enrolled in Medicare?

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

When was this NPI record last updated?

The NPPES record for Benjamin Ly was last updated on September 2, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 days 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.