| Ivy Endodontic Group | |
|
12865 Main St Ste #201 Garden Grove CA 92840 | |
| (714) 530-7888 | |
| (714) 530-1344 |
| Full Name | Ivy Endodontic Group |
|---|---|
| Speciality | Dentist - Endodontics |
| Location | 12865 Main St Ste #201, Garden Grove, California |
| Authorized Official Name and Position | Michael Hwangsuk Kim (OWNER) |
| Authorized Official Contact | 7145307888 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ivy Endodontic Group 12865 Main St Ste #201 Garden Grove CA 92840 Ph: (714) 530-7888 | Ivy Endodontic Group 12865 Main St Ste #201 Garden Grove CA 92840 Ph: (714) 530-7888 |
| NPI Number | 1629186176 |
|---|---|
| Provider Enumeration Date | 08/25/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629186176 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223E0200X | Dentist - Endodontics | 36953 (California) | Primary |
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