Active NPI
Mike Chang-Gu Yeo
- Dentist
- Chantilly, VA
National Provider Identifier
1356534325
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 0401007714
- Practice address
- 13916 Metrotech Dr
Chantilly, VA 20151-3238 - Phone
- (703) 488-9922
- Fax
- (703) 263-0808
- NPI assigned
- Aug 23, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 0401007714 | VA | Primary |
Addresses
Primary practice location
13916 Metrotech Dr
Chantilly, VA 20151-3238
Mailing address
13916 Metrotech Dr
Chantilly, VA 20151-3238
Phone (703) 488-9922
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 |
|---|---|---|---|
| 0401007714 | VA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1187827200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1187827200000",
"number": "1356534325",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13916 METROTECH DR",
"city": "CHANTILLY",
"state": "VA",
"postal_code": "201513238",
"telephone_number": "703-488-9922",
"fax_number": "703-263-0808"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13916 METROTECH DR",
"city": "CHANTILLY",
"state": "VA",
"postal_code": "201513238",
"telephone_number": "703-488-9922",
"fax_number": "703-263-0808"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YEO",
"first_name": "MIKE",
"middle_name": "CHANG-GU",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-08-23",
"last_updated": "2007-08-23",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "VA",
"license": "0401007714",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chantilly, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.