Provider Demographics
NPI:1891762886
Name:HO, IVAN W (DDS)
Entity Type:Individual
Prefix:DR
First Name:IVAN
Middle Name:W
Last Name:HO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 CALLE ELEGANTE
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-8915
Mailing Address - Country:US
Mailing Address - Phone:949-322-7888
Mailing Address - Fax:
Practice Address - Street 1:24953 PASEO DE VALENCIA STE 6C
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-4337
Practice Address - Country:US
Practice Address - Phone:949-880-6638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice