Yakov Shimunov, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

23164 Issued in FL

Practice address

651 Nautica Dr # 1
Jacksonville, FL 32218-7222

Phone

(347) 422-3596

NPI assigned

May 26, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1495756800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623542400000",
    "number": "1194253765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2586 SCOTT MILL DR S",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322236528",
            "telephone_number": "347-422-3596"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "651 NAUTICA DR # 1",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322187222",
            "telephone_number": "347-422-3596"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIMUNOV",
        "first_name": "YAKOV",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-05-26",
        "last_updated": "2021-06-13",
        "certification_date": "2021-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "23164",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Susana Shih
• Mozetta C Shiloh
• Meredith Shimp, DPT
• Karen S Shimshak, MD
• Serena Jane Elizabeth Shimshak, MD
• Junghye Shin, AU.D.
• Dionna Shine, PHARMD
• Sarah Shine
• Timothy Shine, MD
• Tracy Shingle-Bratton

• General Practice Dentistry in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 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.

Verify at the official NPI Registry.