KIM SHIMAZU & LEE DENTAL CORP (NPI# 1629186176) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629186176 |
| Entity Type | Organization |
| Organization Name | KIM SHIMAZU & LEE DENTAL CORP |
| Other Organization Name | IVY ENDODONTIC GROUP |
| Practice Address |
12865 Main St Ste #201 Garden Grove CA 92840 |
| Practice Telephone | 7145307888 |
| Practice Fax Number | 7145301344 |
| Mailing Telephone | 7145307888 |
| Mailing Fax Number | 7145301344 |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MR. MICHAEL HWANGSUK KIM (OWNER) |
| Authorized Official Telephone | 7145307888 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223E0200X |
Dentist Specialization: Endodontics |
36953 | CA | Dental Providers |
| Other Name | Type Code |
|---|---|
| Ivy Endodontic Group | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982882072 | Kim Shimazu & Lee Dental Corp | Dentist | 4040 Barranca Pkwy, Suite 135a, Irvine, CA 92604 | 2008-01-31 |
| Street Address |
12865 MAIN ST STE #201 |
| City | GARDEN GROVE |
| State | CA |
| Zip Code | 92840 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588283808 | Kimberly Gaeta | Behavioral Analyst | 123935 Lewis Street, Ste 202, Garden Grove, CA 92840 | 2020-04-16 |
| 1396397170 | Rosa Cortez | Behavior Technician | 12443 Lewis Street, #201, Garden Grove, CA 92840 | 2019-07-12 |
| 1376005934 | Sekboppa Sor | Nurse Practitioner | An Lanh Free Clinic, 10861 Acacia Pkwy., Garden Grove, CA 92840 | 2019-04-03 |
| 1346730116 | Vinh Le Tran | Pharmacist | 12666 Brookhurst St. Suite 110, Garden Grove, CA 92840 | 2018-05-16 |
| 1841715232 | Scott R. Blair | Physician Assistant | 12828 Harbor Blvd Ste 200, Garden Grove, CA 92840 | 2017-08-07 |
| 1881049492 | Carmen Keally | Dietitian, Registered | 12602 9th St, Garden Grove, CA 92840 | 2016-05-02 |
| 1548688732 | House Call Medical Associates, Inc. | Internal Medicine | 12865 Main St Ste 105, Garden Grove, CA 92840 | 2014-04-03 |
| 1851733059 | Carly Ann Wade | Marriage & Family Therapist | 12755 Brookhurst St. Ste 116, Garden Grove, CA 92840 | 2013-07-29 |
| 1003159864 | Priyal Shah Ohri | Dentist | 10602 Chapman Ave, Suite 200, Garden Grove, CA 92840 | 2013-03-30 |
| 1770853244 | Joseph Pham | Pharmacist | 12001 Euclid St., Garden Grove, CA 92840 | 2011-12-30 |
| Find all providers in zip 92840 | ||||
| Taxonomy Code | 1223E0200X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Endodontics |
| The branch of dentistry that is concerned with the morphology, physiology and pathology of the human dental pulp and periradicular tissues. Its study and practice encompass the basic and clinical sciences including biology of the normal pulp, the etiology, diagnosis, prevention and treatment of diseases and injuries of the pulp and associated periradicular conditions. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336476373 | Michael Hwangsuk Kim | Dentist | 12865 Main St, #201, Garden Grove, CA 92840-8205 | 2009-11-12 |
| 1992959597 | Christine Jung | Dentist | 8321 Garden Grove Blvd, Garden Grove, CA 92844-1145 | 2008-11-10 |
| 1588751176 | Stephen Paik | Dentist | 9095 Central Ave, #a, Garden Grove, CA 92844-1320 | 2006-10-06 |
| 1952324550 | John Michael Lies | Dentist | 12777 Valley View St Ste 252, Garden Grove, CA 92845-2522 | 2006-07-25 |
| 1649599523 | Loo, Hsiao, & Tsai, A Professional Corporation | Dentist | 12828 Harbor Blvd, 350, Garden Grove, CA 92840-5831 | 2010-05-18 |
| 1356364962 | Patrick J. Garrett | Dentist | 12777 Valley View St Ste 252, Garden Grove, CA 92845-2522 | 2006-07-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619578655 | Pinole Endodontics | Dentist | 2150 Appian Way Ste 207, Pinole, CA 94564-2520 | 2020-11-05 |
| 1518566702 | Sp Endodontics Partnershiop | Dentist | 1300 W Lodi Ave Ste N, Lodi, CA 95242-3038 | 2020-10-20 |
| 1215535661 | Ascella Justine Ronson | Dentist | 35395 Linda Rosea Rd, Temecula, CA 92592-9532 | 2020-10-16 |
| 1457964215 | Lars Bjorn Jonsson, D.d.s., M.s., Inc. | Dentist | 25261 Paseo De Valencia Ste 3, Laguna Hills, CA 92637-4966 | 2020-08-31 |
| 1952929333 | Noureldin Shoreibah Dds Inc | Dentist | 7677 Center Ave Ste 210, Huntington Beach, CA 92647-9103 | 2020-07-11 |
| 1558984799 | Integrative Endodontics, Inc | Dentist | 10850 Wilshine Blvd Ste 301, Los Angeles, CA 90027 | 2020-05-22 |
| 1568091833 | M. Potti Dds Msd Inc | Dentist | 6400 Village Pkwy Ste 100, Dublin, CA 94568-3007 | 2020-04-07 |
| 1194356840 | Liang Dental Group Inc | Dentist | 5562 Philadelphia St Ste 211, Chino, CA 91710-2499 | 2020-01-31 |
| 1699313015 | Paul Erben Dmd Msd PC | Dentist | 937 E Main St Ste 204, Santa Maria, CA 93454-5309 | 2019-12-16 |
| 1396382495 | Narbeh Bandary Dental Corp | Dentist | 4910 Van Nuys Blvd Ste 100, Sherman Oaks, CA 91403-1718 | 2019-12-08 |
| Find all providers with the same taxonomy | ||||
| City | GARDEN GROVE |
| Zip Code | 92840 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.