Active NPI
You Jia, DDS
- Dentist
- Penfield, NY
National Provider Identifier
1114230570
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 055674
- Practice address
- 2100 Penfield Rd
Penfield, NY 14526-1736 - Phone
- (585) 364-2829
- NPI assigned
- Jul 14, 2010
- Last updated
- Jun 14, 2019
- Sex
- Female
- Sole proprietor
- No
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 | 055674 | NY | Primary |
Addresses
Primary practice location
2100 Penfield Rd
Penfield, NY 14526-1736
Mailing address
2100 Penfield Road
Penfield
Penfield, NY 14526
Phone (585) 275-5051
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 2, 2021 through Apr 2, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 055674 | NY | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1279065600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1560470400000",
"number": "1114230570",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2100 PENFIELD ROAD",
"address_2": "PENFIELD",
"city": "PENFIELD",
"state": "NY",
"postal_code": "14526",
"telephone_number": "585-275-5051"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2100 PENFIELD RD",
"city": "PENFIELD",
"state": "NY",
"postal_code": "145261736",
"telephone_number": "585-364-2829"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JIA",
"first_name": "YOU",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-07-14",
"last_updated": "2019-06-14",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": "055674",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Penfield, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.