MEDICARE: IN GI SON DDS 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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1285527929
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IN GI SON DDS INC

Provider Business Mailing Address
First Line	:	329 WHITE CAP LN
Second Line	:
City	:	NEWPORT COAST
State	:	CA
Zip	:	92657-1095
Country	:	US
Telephone Number	:	415-672-3509
Fax Number	:

Provider Business Practice Location Address
First Line	:	602 S HARBOR BLVD
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92704-1340
Country	:	US
Telephone Number	:	415-672-3509
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	IN GI SON
Credential	:	DDS
Telephone Number	:	415-672-3509

Provider Enumeration Date	:	06/02/2025
Last Update Date	:	06/02/2025

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