Active NPI
Yonghwi Moon
- Dentist
- Waukegan, IL
National Provider Identifier
1336677665
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 019031432
- Practice address
- 2821 Grand Ave
Waukegan, IL 60085 - Phone
- (847) 662-4400
- NPI assigned
- May 31, 2017
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Dentist | 122300000X | 019031432 | IL | Primary |
Addresses
Primary practice location
2821 Grand Ave
Waukegan, IL 60085
Mailing address
1009 Hilldale LN
Buffalo Grove, IL 60089-7017
Phone (585) 683-0248
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 |
|---|---|---|---|
| 019031432 | IL | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| My Dental LLC | Past | Accepting new patients | |
| Dental Experts, LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Dentistry
- Hoffman Estates, IL
- NPI 1891601852
-
- General Practice Dentistry
- Waukegan, IL
- NPI 1245487792
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1496188800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1530057600000",
"number": "1336677665",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1009 HILLDALE LN",
"city": "BUFFALO GROVE",
"state": "IL",
"postal_code": "600897017",
"telephone_number": "585-683-0248"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2821 GRAND AVE",
"city": "WAUKEGAN",
"state": "IL",
"postal_code": "60085",
"telephone_number": "847-662-4400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOON",
"first_name": "YONGHWI",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-05-31",
"last_updated": "2018-06-27",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "019031432",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waukegan, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.