Individual provider Active NPI

Sharon Thao VI Tu, DMD

  • General Practice Dentistry
  • Jackson, CA
National Provider Identifier
1013806900
Registry record updated Jul 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
111736 Issued in CA
Practice address
12150 New York Ranch Rd
Jackson, CA 95642-9407
Phone
(209) 257-2460
NPI assigned
Jul 2, 2025
Last updated
Jul 2, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 111736 CA Primary

Addresses

Primary practice location

12150 New York Ranch Rd
Jackson, CA 95642-9407

Mailing address

12150 New York Ranch Rd
Jackson, CA 95642-9407

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250725002242 TX Practitioner - Dentist 6406363472 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
M a C T Health Board Incorporated CurrentSince Aug 4, 2025 Accepting new patients
M a C T Health Board Incorporated CurrentSince Aug 4, 2025 Accepting new patients
M a C T Health Board Incorporated Past Accepting new patients
M a C T Health Board, Incorporated General Practice Past Accepting new patients
M a C T Health Board, Incorporated General Practice Past Accepting new patients
M a C T Health Board, Incorporated Past Accepting new patients
M a C T Health Board Incorporated Past Accepting new patients

Locations

19177 State Highway 120
Groveland, CA 95321
Phone (209) 754-6262

12140 New York Ranch Rd
Jackson, CA 95642
Phone (209) 257-2400

12150 New York Ranch Rd
Jackson, CA 95642
Phone (209) 257-2400

13975 Mono Way
Ste I
Sonora, CA 95370
Phone (209) 533-9603

Interoperability endpoints

  • Direct secure messaging: sharon.tu.p1@direct.macthealth.nextgenshare.com

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1751414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751414400000",
    "number": "1013806900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12150 NEW YORK RANCH RD",
            "city": "JACKSON",
            "state": "CA",
            "postal_code": "956429407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12150 NEW YORK RANCH RD",
            "city": "JACKSON",
            "state": "CA",
            "postal_code": "956429407",
            "telephone_number": "209-257-2460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TU",
        "first_name": "SHARON",
        "middle_name": "THAO VI",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-07-02",
        "last_updated": "2025-07-02",
        "certification_date": "2025-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "111736",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, CA

Sources for this page

Verify at the official NPI Registry.