UCLA GRAD ENDO CLINIC NPI 1063630267

NPI Information

  • NPI: 1063630267
  • Provider Name: UCLA GRAD ENDO CLINIC
  • Classification: Dentist - 1223E0200X
  • Specialization: Endodontics
  • Entity Type: Organization
  • Address: 10833 LE CONTE AVE
    SUITE 30-125 CHS
    LOS ANGELES, CA
    ZIP 90095
  • Phone: (310) 825-4348

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NPI Details

UCLA GRAD ENDO CLINIC is an endodontics dentist in Los Angeles, CA. The provider is the branch of dentistry that is concerned with the morphology, physiology and pathology of the human dental pulp and periradicular tissues. Its study and practice encompass the basic and clinical sciences including biology of the normal pulp, the etiology, diagnosis, prevention and treatment of diseases and injuries of the pulp and associated periradicular conditions. UCLA GRAD ENDO CLINIC NPI is 1063630267. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

10833 LE CONTE AVE
SUITE 30-125 CHS
LOS ANGELES, CA
ZIP 90095-668
Phone: (310) 825-4348
Fax: (310) 206-5030

The provider's authorized official is Mo Kwan Kang .
The authorized official title is Assoc. Professor and has the following contact phone number (310) 825-8048.

The enumeration date for this NPI number is 4/23/2007 and was last updated on 10/2/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
11223E0200XDentistEndodonticsD51343CALIFORNIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1G01005-01MEDICAIDCALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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