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Organization
IVY O. LI D.D.S. INC.
Active
Organization
IVY O. LI D.D.S. INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. IVY OI-WAN LI D.D.S. (PRESIDENT)
(213) 617-0136
Entity
Organization
Contact information
Practice address
420 ORD ST, SUITE #102, LOS ANGELES, CA 90012-2834
(213) 617-0136
Mailing address
420 ORD ST, SUITE #102, LOS ANGELES, CA 90012-2834
(213) 617-0136
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
26674
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
B26674-01
DENTICAL
CA
Enumeration date
12/01/2006
Last updated
06/12/2012
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