Individual provider Active NPI

Yoonsun Jang

  • General Practice Dentistry
  • San Mateo, CA
National Provider Identifier
1033072350
Registry record updated Dec 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DDS112139 Issued in CA
Practice address
675 Mariners Island Blvd Ste 105
San Mateo, CA 94404-1040
Phone
(650) 345-5711
NPI assigned
Dec 4, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 4, 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 DDS112139 CA Primary

Addresses

Primary practice location

675 Mariners Island Blvd Ste 105
San Mateo, CA 94404-1040

Mailing address

675 Mariners Island Blvd Ste 105
San Mateo, CA 94404-1040
Phone (650) 345-5711

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

LicenseStateTypeSpecialty
DDS112139CAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
D Kim DMD CurrentSince Dec 7, 2025 Accepting new patients

Locations

675 Mariners Island Blvd
Ste 105
San Mateo, CA 94404
Phone (650) 345-5711

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1764806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764806400000",
    "number": "1033072350",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "675 MARINERS ISLAND BLVD STE 105",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944041040",
            "telephone_number": "650-345-5711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "675 MARINERS ISLAND BLVD STE 105",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944041040",
            "telephone_number": "650-345-5711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JANG",
        "first_name": "YOONSUN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-12-04",
        "last_updated": "2025-12-04",
        "certification_date": "2025-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "DDS112139",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Mateo, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.