Healthcare Provider Details

I. General information

NPI: 1245147081
Provider Name (Legal Business Name): AMI IKEDA DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4132 UNIVERSITY AVE
SAN DIEGO CA
92105-1419
US

IV. Provider business mailing address

1462 EL PRADO AVE
LEMON GROVE CA
91945-4312
US

V. Phone/Fax

Practice location:
  • Phone: 619-280-3373
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDDS113556
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: