Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Jennifer Phuong Ly

Individual provider Physician Assistant · NPI 1316783202

Jennifer Phuong Ly is a Physician Assistant in Los Angeles, California. Qualified in 2024, 2 years ago. Licensed in California.

Years since qualifying
2
Licensed in
CA
In the registry since
2024

Practice location Address checks out

1500 San Pablo St
Los Angeles, CA 90033-5313
Phone: (323) 442-6335
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 65064 (CA)

Record details

NPI number1316783202
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedJuly 1, 2024
Last updated in NPPESNovember 13, 2025
Certification dateNovember 13, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

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