Individual
IVY FUA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
925 W 34TH ST, LOS ANGELES, CA 90089-0058
(213) 740-0412
Mailing address
1360 S FIGUEROA ST, LOS ANGELES, CA 90015-2873
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
00000
CA
Other
Enumeration date
04/07/2017
Last updated
04/07/2017
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