MEDICARE: IVY HEALTH INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	AC11453	CA

General Provider Information

NPI Number	:	1215189832
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IVY HEALTH INC.

Provider Business Mailing Address
First Line	:	355 PLACENTIA AVE STE 210
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92663-3302
Country	:	US
Telephone Number	:	949-722-7088
Fax Number	:	949-722-8850

Provider Business Practice Location Address
First Line	:	355 PLACENTIA AVE STE 210
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92663-3302
Country	:	US
Telephone Number	:	949-722-7088
Fax Number	:	949-722-8850

Authorized Official
Title or Position	:	CEO
Name	:	DR. LIQUN XIA
Credential	:	L.AC.
Telephone Number	:	949-722-7088

Provider Enumeration Date	:	10/14/2008
Last Update Date	:	10/14/2008

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