Active NPI
Jaesuk Yoo
- General Practice Dentistry
- JB Andrews, MD
National Provider Identifier
1225010549
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DS036246
- Practice address
- 1065 W. Perimeter Rd
316 DS
JB Andrews, MD 20762 - Phone
- (402) 612-2544
- NPI assigned
- Nov 14, 2005
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DS036246 | PA | Primary |
Addresses
Primary practice location
1065 W. Perimeter Rd
316 DS
JB Andrews, MD 20762
Mailing address
3722 Ridgelea Dr
Fairfax, VA 22031-3231
Phone (253) 455-8656
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 |
|---|---|---|---|
| DS036246 | PA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1131926400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1739836800000",
"number": "1225010549",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3722 RIDGELEA DR",
"city": "FAIRFAX",
"state": "VA",
"postal_code": "220313231",
"telephone_number": "253-455-8656"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1065 W. PERIMETER RD",
"address_2": "316 DS",
"city": "JB ANDREWS",
"state": "MD",
"postal_code": "20762",
"telephone_number": "402-612-2544"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YOO",
"first_name": "JAESUK",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-14",
"last_updated": "2025-02-18",
"certification_date": "2025-02-13",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "PA",
"license": "DS036246",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in JB Andrews, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.