Provider Demographics
NPI:1437952967
Name:MICHAEL M.B
Entity type:Organization
Organization Name:MICHAEL M.B
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:MB
Authorized Official - Last Name:LY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:626-300-9251
Mailing Address - Street 1:2447 W VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91803-1933
Mailing Address - Country:US
Mailing Address - Phone:626-300-9251
Mailing Address - Fax:
Practice Address - Street 1:2447 W VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91803-1933
Practice Address - Country:US
Practice Address - Phone:626-300-9251
Practice Address - Fax:626-300-8911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care