Individual provider Active NPI

Yong Woo Jeon, DDS

  • Student in an Organized Health Care Education/Training Program
  • Toledo, OH
National Provider Identifier
1154983120
Registry record updated Jun 30, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
3000 Arlington Ave, Mailstop 1132
Toledo, OH 43614
Phone
(419) 383-3805
Fax
(419) 383-2969
NPI assigned
Jun 30, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

3000 Arlington Ave, Mailstop 1132
Toledo, OH 43614

Mailing address

3000 Arlington Ave, Mailstop 1132
Toledo, OH 43614
Phone (419) 383-3805

Other practice location 1

3000 Arlington Ave
Toledo, OH 43614-2595
Phone (419) 383-3504

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190724004154 OH Order and Referring Only - DentistPractitioner - Dentist 9537495874

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1561852800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561852800000",
    "number": "1154983120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3000 ARLINGTON AVE, MAILSTOP 1132",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "43614",
            "telephone_number": "419-383-3805",
            "fax_number": "419-383-2969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 ARLINGTON AVE, MAILSTOP 1132",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "43614",
            "telephone_number": "419-383-3805",
            "fax_number": "419-383-2969"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3000 Arlington Ave",
            "address_purpose": "LOCATION",
            "city": "Toledo",
            "state": "OH",
            "postal_code": "436142595",
            "country_code": "US",
            "telephone_number": "419-383-3504",
            "fax_number": "419-383-6127",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JEON",
        "first_name": "YONG WOO",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-30",
        "last_updated": "2019-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Toledo, OH

Sources for this page

Verify at the official NPI Registry.