Active NPI
Ilcheon Joo, D.D.S
- Dentist
- Pine Grove, PA
National Provider Identifier
1063530509
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DS037775
- Practice address
- 46 Mifflin St
Pine Grove, PA 17963-1318 - Phone
- (570) 345-3495
- Fax
- (570) 345-3161
- NPI assigned
- Mar 26, 2007
- Sex
- Male
- 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 | DS037775 | PA | Primary |
Addresses
Primary practice location
46 Mifflin St
Pine Grove, PA 17963-1318
Mailing address
6690 Hauser Rd
M101
Macungie, PA 18062-8102
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 |
|---|---|---|---|
| DS037775 | PA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Stephen D Muench DDS PC | Past | Accepting new patients | |
| Ilcheon Joo DDS PC | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Dental Clinic/Center
- Pine Grove, PA
- NPI 1699006452
-
- Dental Clinic/Center
- Pine Grove, PA
- NPI 1144404922
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174867200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1260230400000",
"number": "1063530509",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6690 HAUSER RD",
"address_2": "M101",
"city": "MACUNGIE",
"state": "PA",
"postal_code": "180628102"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "46 MIFFLIN ST",
"city": "PINE GROVE",
"state": "PA",
"postal_code": "179631318",
"telephone_number": "570-345-3495",
"fax_number": "570-345-3161"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOO",
"first_name": "ILCHEON",
"name_prefix": "Dr.",
"credential": "D.D.S",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-26",
"last_updated": "2009-12-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "PA",
"license": "DS037775",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pine Grove, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 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.