Provider Demographics
NPI:1215189832
Name:IVY HEALTH INC.
Entity type:Organization
Organization Name:IVY HEALTH INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LIQUN
Authorized Official - Middle Name:
Authorized Official - Last Name:XIA
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:949-722-7088
Mailing Address - Street 1:355 PLACENTIA AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3302
Mailing Address - Country:US
Mailing Address - Phone:949-722-7088
Mailing Address - Fax:949-722-8850
Practice Address - Street 1:355 PLACENTIA AVE STE 210
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3302
Practice Address - Country:US
Practice Address - Phone:949-722-7088
Practice Address - Fax:949-722-8850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-14
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11453171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty