| Ivy Endotontic Group | |
|
4040 Barranca Pkwy Ste 135a Irvine CA 92604-4773 | |
| (949) 262-1300 | |
| (949) 262-0453 |
| Full Name | Ivy Endotontic Group |
|---|---|
| Speciality | Clinic/Center |
| Location | 4040 Barranca Pkwy Ste 135a, Irvine, California |
| Authorized Official Name and Position | Mary Um (PRESIDENT) |
| Authorized Official Contact | 2489432307 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ivy Endotontic Group 4040 Barranca Pkwy Ste 135a Irvine CA 92604-4773 Ph: (949) 262-1300 | Ivy Endotontic Group 4040 Barranca Pkwy Ste 135a Irvine CA 92604-4773 Ph: (949) 262-1300 |
| NPI Number | 1821757089 |
|---|---|
| Provider Enumeration Date | 12/14/2021 |
| Last Update Date | 05/10/2022 |
| Medicare PECOS PAC ID | 9638566441 |
|---|---|
| Medicare Enrollment ID | O20220426002022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821757089 | NPI | - | NPPES |
| 107104 | Other | CA | DENTIST |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223E0200X | Dentist - Endodontics | (* (Not Available)) | Secondary |
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
| Provider Name | Mary Junghyun Um |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1952612988 PECOS PAC ID: 7911394721 Enrollment ID: I20220426001976 |
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