Active NPI
Wiley Yao
- Periodontics
- Homewood, IL
National Provider Identifier
1124518188
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 021.003109
- Practice address
- 18130 Halsted St
Homewood, IL 60430-2597 - Phone
- (708) 799-2550
- NPI assigned
- May 15, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Periodontics | 1223P0300X | 021.003109 | IL | Primary |
Addresses
Primary practice location
18130 Halsted St
Homewood, IL 60430-2597
Mailing address
M205 Candlewood CT
Marshfield, WI 54449-8855
Phone (715) 897-7898
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 021.003109 | IL | MD | Periodontist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Endodontic & Periodontic Associates, LTD | Periodontics | Past | Accepting new patients |
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": "1526342400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1632787200000",
"number": "1124518188",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "M205 CANDLEWOOD CT",
"city": "MARSHFIELD",
"state": "WI",
"postal_code": "544498855",
"telephone_number": "715-897-7898"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18130 HALSTED ST",
"city": "HOMEWOOD",
"state": "IL",
"postal_code": "604302597",
"telephone_number": "708-799-2550"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YAO",
"first_name": "WILEY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-05-15",
"last_updated": "2021-09-28",
"certification_date": "2021-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "IL",
"license": "021.003109",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Homewood, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.