John Emery Tillner Jr., DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

52944 Issued in CA

Practice address

752 Medical Center CT
#205
Chula Vista, CA 91911-6658

Phone

(619) 482-6774

Fax

(619) 482-7637

NPI assigned

Oct 12, 2007

Last updated

May 18, 2010By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Opted out of Medicare

Yes, effective Feb 1, 2020 through Feb 1, 2028

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• John Tillner Dental Corporation

  • Oral and Maxillofacial Surgery (Dentist)
  • Chula Vista, CA
  • NPI 1730485657
  NPD (past) Authorized official

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

{
    "created_epoch": "1192147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1274140800000",
    "number": "1316135452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "752 MEDICAL CENTER CT",
            "address_2": "#205",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919116658",
            "telephone_number": "619-482-6774",
            "fax_number": "619-482-7637"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "752 MEDICAL CENTER CT",
            "address_2": "#205",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919116658",
            "telephone_number": "619-482-6774",
            "fax_number": "619-482-7637"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TILLNER",
        "first_name": "JOHN",
        "middle_name": "EMERY",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-10-12",
        "last_updated": "2010-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "52944",
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IL",
            "license": "021002336",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Earl Aeron Angelo Tuazon Timpog
• San Aye Tin, D.D.S.

• Oral and Maxillofacial Surgery (Dentist) in Chula Vista, CA
• Providers in Chula Vista, CA by specialty
• Oral and Maxillofacial Surgery (Dentist) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.