Yiran Xu, DMD

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

019.034076 Issued in IL

Practice address

4160 Il-83
Ste 308
Long Grove, IL 60047

Phone

(847) 634-6166

NPI assigned

May 9, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

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 and National Provider Directory roles.

• Professional Dental Alliance of Illinois Specialty, PLLC

  • Pediatric Dentistry
  • Long Grove, IL
  • NPI 1558145227
  NPD

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

{
    "created_epoch": "1620518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692057600000",
    "number": "1376127092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 YORK ST",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065103220",
            "telephone_number": "203-688-4242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4160 IL-83",
            "address_2": "STE 308",
            "city": "LONG GROVE",
            "state": "IL",
            "postal_code": "60047",
            "telephone_number": "847-634-6166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "XU",
        "first_name": "YIRAN",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-05-09",
        "last_updated": "2023-08-15",
        "certification_date": "2023-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "IL",
            "license": "019.034076",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tricia Helen Ward, APN
• Mindy Waxman, PSY.D.
• Lora White
• Wunderlich Counseling & Consulting LTD.
• Raymond C. Wunderlich Jr., L.C.P.C.
• Kristin Yates, NP
• Michelle N Zmick, D.D,S,

• Pediatric Dentistry in Long Grove, IL
• Providers in Long Grove, IL by specialty
• Pediatric Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.