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General NPI Number Information
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NPI Number | 1215189832
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Entity Type | Organization
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Legal Business Name | IVY HEALTH INC.
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Dates
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Enumeration Date | 10/14/2008
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Last Update Date | 10/14/2008
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Provider Practice Location Address
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Address Line | 355 PLACENTIA AVE STE 210
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City | NEWPORT BEACH
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State | CA
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Zip | 92663-3302
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Country | US
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Telephone | 949-722-7088
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Fax | 949-722-8850
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Provider Business Mailing Address
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Address Line | 355 PLACENTIA AVE STE 210
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City | NEWPORT BEACH
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State | CA
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Zip | 92663-3302
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Country | US
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Telephone | 949-722-7088
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Fax | 949-722-8850
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Authorized Official
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Title or Position | CEO
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Name | DR. LIQUN XIA
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Credential | L.AC.
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Telephone | 949-722-7088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC11453
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License Number State | CA
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