NPIMap

Organization Active NPI

Guam Dermatology Institute LLC

Doing business as Guam Dermatology Institute

  • Dermatology Physician
  • Tamuning, GU
National Provider Identifier
1306404413
Registry record updated Oct 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
GUAM DERMATOLOGY INSTITUTE LLC
Doing business as
Guam Dermatology Institute
Practice address
633 Gov Carlos G Camacho Rd Ste 102
Tamuning, GU 96913-3143
Phone
(671) 588-5001
Fax
(671) 649-5003
NPI assigned
Jun 4, 2019
Last updated
Oct 11, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2019

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

Authorized official

Name
Dr. Hoseong Yang, MD PHDNPI 1922323500
Title
Medical Director
Phone
(671) 588-5001

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X NU Primary

Addresses

Primary practice location

633 Gov Carlos G Camacho Rd Ste 102
Tamuning, GU 96913-3143

Mailing address

633 Gov Carlos G Camacho Rd Ste 102
Tamuning, GU 96913-3143
Phone (671) 588-5001

Other practice location 1

543 Chalan Guma Yuos St
Tamuning, GU 96913-3630
Phone (671) 646-9696

Other names 1

  • Guam Dermatology Institute Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GU

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191218001233 GU Part B Supplier - Clinic/Group Practice 7012341456 Receives reassigned benefits from 8 practitioners
Practice locations: Tamuning, GU

National Provider Directory

National Provider Directory

Locations

633 Gov Carlos G Camacho Rd
Ste 102
Tamuning, GU 96913
Phone (671) 588-5001

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1559606400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570752000000",
    "number": "1306404413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "633 GOV CARLOS G CAMACHO RD STE 102",
            "city": "TAMUNING",
            "state": "GU",
            "postal_code": "969133143",
            "telephone_number": "671-588-5001",
            "fax_number": "671-649-5003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "633 GOV CARLOS G CAMACHO RD STE 102",
            "city": "TAMUNING",
            "state": "GU",
            "postal_code": "969133143",
            "telephone_number": "671-588-5001",
            "fax_number": "671-649-5003"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "543 Chalan Guma Yuos St",
            "address_purpose": "LOCATION",
            "city": "Tamuning",
            "state": "GU",
            "postal_code": "969133630",
            "country_code": "US",
            "telephone_number": "671-646-9696",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GUAM DERMATOLOGY INSTITUTE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-04",
        "last_updated": "2019-10-11",
        "status": "A",
        "authorized_official_last_name": "YANG",
        "authorized_official_first_name": "HOSEONG",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "671-588-5001",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD PHD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Guam Dermatology Institute",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Guam Dermatology Institute",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tamuning, GU

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.