Provider Demographics
NPI:1205159498
Name:IKEDA, HIDEKI (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:HIDEKI
Middle Name:
Last Name:IKEDA
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12777 VALLEY VIEW ST STE 222
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92845-2522
Mailing Address - Country:US
Mailing Address - Phone:714-893-7539
Mailing Address - Fax:
Practice Address - Street 1:12777 VALLEY VIEW ST STE 222
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92845-2522
Practice Address - Country:US
Practice Address - Phone:714-893-7539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA584041223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics