Jim Yu, D.D.S. Professional Dental Corporation

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

JIM YU, D.D.S. PROFESSIONAL DENTAL CORPORATION

Practice address

2231 W Grant Line Rd Ste 134
Tracy, CA 95377-7325

Phone

(209) 227-2579

NPI assigned

Nov 26, 2014

Organization subpart

Yes

Parent organization

JIM YU, D.D.S. PROFESSIONAL DENTAL CORPORATIONAs reported in NPPES

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

Authorized official

Name

Lindsay Bearden

Title

Credentialing Coordinator

Phone

(217) 540-5699

Specialties & licenses 1

Addresses

Other names 1

• Tracy Orchard Dental Care Doing business as

Part of

Jim Yu DDS Professional Dental Corporation

Locations

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

{
    "created_epoch": "1416960000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1416960000000",
    "number": "1255738787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2231 W GRANT LINE RD STE 134",
            "city": "TRACY",
            "state": "CA",
            "postal_code": "953777325",
            "telephone_number": "209-227-2579"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2231 W GRANT LINE RD STE 134",
            "city": "TRACY",
            "state": "CA",
            "postal_code": "953777325",
            "telephone_number": "209-227-2579"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JIM YU, D.D.S. PROFESSIONAL DENTAL CORPORATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JIM YU, D.D.S. PROFESSIONAL DENTAL CORPORATION",
        "enumeration_date": "2014-11-26",
        "last_updated": "2014-11-26",
        "status": "A",
        "authorized_official_last_name": "BEARDEN",
        "authorized_official_first_name": "LINDSAY",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "217-540-5699"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tracy Orchard Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Cody Jean, LCSW
• Jefferson School District
• Kaitlin Jenks
• Alecia Rae Jeppson, LCSW
• Susan Kathleen Jessee
• Karen Jimenez Lopez
• Alejandra Jimenez Lozano
• Eileen Jimenez Medina
• Maribel Jimenez Ramos
• Brenda Jimenez

• General Practice Dentistry in Tracy, CA
• Providers in Tracy, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2014; 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.