Active NPI
Boram Yoo
- Dentist
- Santa Monica, CA
National Provider Identifier
1033563291
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 56697
- Practice address
- 1128 19TH St
Santa Monica, CA 90403-5629 - Phone
- (310) 406-3000
- NPI assigned
- Apr 14, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 56697 | CA | Primary |
Addresses
Primary practice location
1128 19TH St
Santa Monica, CA 90403-5629
Mailing address
1128 19TH St
Santa Monica, CA 90403-5629
Phone (310) 406-3000
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 |
|---|---|---|---|
| 56697 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1460592000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1460592000000",
"number": "1033563291",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1128 19TH ST",
"city": "SANTA MONICA",
"state": "CA",
"postal_code": "904035629",
"telephone_number": "310-406-3000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1128 19TH ST",
"city": "SANTA MONICA",
"state": "CA",
"postal_code": "904035629",
"telephone_number": "310-406-3000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YOO",
"first_name": "BORAM",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-04-14",
"last_updated": "2016-04-14",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "56697",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santa Monica, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.