NPIMap

Organization Active NPI

UCLA Grad Endo Clinic

  • Endodontics
  • Los Angeles, CA
National Provider Identifier
1063630267
Registry record updated Oct 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
EndodonticsTaxonomy code 1223E0200X
License
D51343 Issued in CA
Legal business name
UCLA GRAD ENDO CLINIC
Practice address
10833 Le Conte Ave
Suite 30-125 CHS
Los Angeles, CA 90095-1668
Phone
(310) 825-4348
Fax
(310) 206-5030
NPI assigned
Apr 23, 2007
Last updated
Oct 2, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Mo Kwan Kang, DDSNPI 1770790594
Title
Assoc. Professor
Phone
(310) 825-8048

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endodontics 1223E0200X D51343 CA Primary

Addresses

Primary practice location

10833 Le Conte Ave
Suite 30-125 CHS
Los Angeles, CA 90095-1668

Mailing address

10833 Le Conte Ave.
CHS 43-007
Los Angeles, CA 90095-1668
Phone (310) 825-8048

Other identifiers 1

IdentifierTypeStateIssuer
G01005-01MedicaidCA

National Provider Directory

National Provider Directory
Tax ID family
Thomas S Klitzner MD56 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 12

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

Locations

10833 Le Conte Ave
#43007
Los Angeles, CA 90095

10833 Le Conte Ave
Ste 30125
Los Angeles, CA 90095
Phone (310) 825-4348

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1759363200000",
    "number": "1063630267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10833 LE CONTE AVE.",
            "address_2": "CHS 43-007",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900951668",
            "telephone_number": "310-825-8048",
            "fax_number": "310-206-5030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10833 LE CONTE AVE",
            "address_2": "SUITE 30-125 CHS",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900951668",
            "telephone_number": "310-825-4348",
            "fax_number": "310-206-5030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UCLA GRAD ENDO CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-23",
        "last_updated": "2025-10-02",
        "certification_date": "2025-10-02",
        "status": "A",
        "authorized_official_last_name": "KANG",
        "authorized_official_first_name": "MO",
        "authorized_official_middle_name": "KWAN",
        "authorized_official_title_or_position": "ASSOC. PROFESSOR",
        "authorized_official_telephone_number": "310-825-8048",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "CA",
            "license": "D51343",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "G01005-01",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.