Active NPI
Young Jun An, DMD
- General Practice Dentistry
- Van Nuys, CA
National Provider Identifier
1447318548
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 43413
- Practice address
- 5658 Sepulveda Blvd Ste 204
Van Nuys, CA 91411-2927 - Phone
- (818) 988-9959
- Fax
- (818) 988-9952
- NPI assigned
- Dec 4, 2006
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 43413 | CA | Primary |
Addresses
Primary practice location
5658 Sepulveda Blvd Ste 204
Van Nuys, CA 91411-2927
Mailing address
5658 Sepulveda Blvd
Ste 204
Sherman Oaks, CA 91411-2927
Phone (818) 988-9959
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Oct 3, 2022 through Oct 3, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 43413 | CA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165190400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1462492800000",
"number": "1447318548",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5658 SEPULVEDA BLVD",
"address_2": "STE 204",
"city": "SHERMAN OAKS",
"state": "CA",
"postal_code": "914112927",
"telephone_number": "818-988-9959",
"fax_number": "818-988-9952"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5658 SEPULVEDA BLVD STE 204",
"city": "VAN NUYS",
"state": "CA",
"postal_code": "914112927",
"telephone_number": "818-988-9959",
"fax_number": "818-988-9952"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AN",
"first_name": "YOUNG",
"middle_name": "JUN",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-04",
"last_updated": "2016-05-06",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "43413",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Van Nuys, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2016; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.