NPIMap

Organization Active NPI

Kim Shimazu & Lee Dental Corp

Doing business as Ivy Endodontic Group

  • Endodontics
  • Irvine, CA
National Provider Identifier
1982882072
Registry record updated Jan 31, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
EndodonticsTaxonomy code 1223E0200X
License
DT36953 Issued in CA
Legal business name
KIM SHIMAZU & LEE DENTAL CORP
Doing business as
Ivy Endodontic Group
Practice address
4040 Barranca Pkwy
Suite 135a
Irvine, CA 92604
Phone
(949) 262-1300
NPI assigned
Jan 31, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2008

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

Authorized official

Name
Michael H Kim, DDSNPI 1336476373
Title
President
Phone
(714) 530-7888

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
EndodonticsGroup: 193200000X MULTI-SPECIALTY GROUP 1223E0200X DT36953 CA Primary

Addresses

Primary practice location

4040 Barranca Pkwy
Suite 135a
Irvine, CA 92604

Mailing address

4040 Barranca Pkwy
Suite 135a
Irvine, CA 92604
Phone (949) 262-1300

Other names 1

  • Ivy Endodontic Group Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Ivy Endodontic Group2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4040 Barranca Pkwy
Ste 135A
Irvine, CA 92604
Phone (949) 262-1300

Practitioners & affiliated clinicians

Practitioners 4

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": "1201737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1201737600000",
    "number": "1982882072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4040 BARRANCA PKWY",
            "address_2": "SUITE 135A",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "92604",
            "telephone_number": "949-262-1300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4040 BARRANCA PKWY",
            "address_2": "SUITE 135A",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "92604",
            "telephone_number": "949-262-1300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIM SHIMAZU & LEE DENTAL CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-31",
        "last_updated": "2008-01-31",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "714-530-7888",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Endodontics",
            "state": "CA",
            "license": "DT36953",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ivy Endodontic Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Irvine, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2008; 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.