Ashbury Dental Clinic Inc

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019024865 Issued in IL

Legal business name

ASHBURY DENTAL CLINIC INC

Practice address

2272 W 95TH St
Suite 315
Naperville, IL 60564-8912

Phone

(630) 717-0111

NPI assigned

Aug 25, 2008

Last updated

Jan 15, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Yong Taek Shim, D.D.S.

Title

President

Phone

(630) 717-0111

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1219622400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1231977600000",
    "number": "1053568824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2272 W 95TH ST",
            "address_2": "SUITE 315",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605648912",
            "telephone_number": "630-717-0111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2272 W 95TH ST",
            "address_2": "SUITE 315",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605648912",
            "telephone_number": "630-717-0111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ASHBURY DENTAL CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-25",
        "last_updated": "2009-01-15",
        "status": "A",
        "authorized_official_last_name": "SHIM",
        "authorized_official_first_name": "YONG",
        "authorized_official_middle_name": "TAEK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "630-717-0111",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019024865",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2009; 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.