NPIMap

Organization Active NPI

Yvonne Shu D.D.S., Inc

  • General Practice Dentistry
  • Pomona, CA
National Provider Identifier
1366599060
Registry record updated Apr 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
41547 Issued in CA
Legal business name
YVONNE SHU D.D.S., INC
Practice address
1640 Indian Hill Blvd
Pomona, CA 91767-3728
Phone
(909) 482-4500
Fax
(909) 482-4502
NPI assigned
Jan 4, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2021

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

Authorized official

Name
Yvonne Shu RodriguezNPI 1356414411
Title
President/ Owner
Phone
(909) 482-4500

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
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 41547 CA Primary

Addresses

Primary practice location

1640 Indian Hill Blvd
Pomona, CA 91767-3728

Mailing address

1640 Indian Hill Blvd
Pomona, CA 91767-3728
Phone (909) 482-4500

Other identifiers 4

IdentifierTypeStateIssuer
771913OtherCAUNITED CONCORDIA
D41547MedicaidCA
B41547OtherCAHEALTHY FAMILIES
G9220601MedicaidCA

Other names 1

  • Pomona Dental Practice Other name

National Provider Directory

National Provider Directory

Locations

1640 Indian Hill Blvd
Pomona, CA 91767
Phone (909) 482-4500

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617753600000",
    "number": "1366599060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1640 INDIAN HILL BLVD",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917673728",
            "telephone_number": "909-482-4500",
            "fax_number": "909-482-4502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1640 INDIAN HILL BLVD",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917673728",
            "telephone_number": "909-482-4500",
            "fax_number": "909-482-4502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YVONNE SHU D.D.S., INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-04",
        "last_updated": "2021-04-07",
        "certification_date": "2021-04-07",
        "status": "A",
        "authorized_official_last_name": "SHU RODRIGUEZ",
        "authorized_official_first_name": "YVONNE",
        "authorized_official_title_or_position": "PRESIDENT/ OWNER",
        "authorized_official_telephone_number": "909-482-4500"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "41547",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "771913",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "D41547",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHY FAMILIES",
            "identifier": "B41547",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "G9220601",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pomona Dental Practice",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Pomona Dental Practice",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Pomona, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2021; 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.