Active NPI
Kwan Ho Yun, DDS
- Pediatric Dentistry
- Elk Grove, CA
National Provider Identifier
1023515723
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 105221
- Practice address
- 5010 Laguna Blvd Ste 101
Elk Grove, CA 95758-4148 - Phone
- (916) 442-7873
- NPI assigned
- Apr 9, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 34850 | TX | |
| Pediatric Dentistry | 1223P0221X | 105221 | CA | Primary |
Addresses
Primary practice location
5010 Laguna Blvd Ste 101
Elk Grove, CA 95758-4148
Mailing address
19144 E Raven Dr
Queen Creek, AZ 85142-6875
Phone (480) 686-5798
Other practice location 1
1895 Mowry Ave Ste 121
Fremont, CA 94538-1736
Phone (510) 791-0971
Other practice location 2
3302 Gaston Ave
Dallas, TX 75246-2013
Phone (214) 828-8100
Other names 1
- Joseph Yun
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 105221 | CA | MD | Pediatric Dentist |
| 34850 | TX | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1523232000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1703980800000",
"number": "1023515723",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19144 E RAVEN DR",
"city": "QUEEN CREEK",
"state": "AZ",
"postal_code": "851426875",
"telephone_number": "480-686-5798"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5010 LAGUNA BLVD STE 101",
"city": "ELK GROVE",
"state": "CA",
"postal_code": "957584148",
"telephone_number": "916-442-7873"
}
],
"practiceLocations": [
{
"address_1": "1895 Mowry Ave Ste 121",
"address_purpose": "LOCATION",
"city": "Fremont",
"state": "CA",
"postal_code": "945381736",
"country_code": "US",
"telephone_number": "510-791-0971",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "3302 Gaston Ave",
"address_purpose": "LOCATION",
"city": "Dallas",
"state": "TX",
"postal_code": "752462013",
"country_code": "US",
"telephone_number": "214-828-8100",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "YUN",
"first_name": "KWAN HO",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-04-09",
"last_updated": "2023-12-31",
"certification_date": "2023-12-31",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "TX",
"license": "34850",
"primary": false
},
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "CA",
"license": "105221",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "JOSEPH",
"last_name": "YUN",
"credential": "DDS",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Elk Grove, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.