Amina Yixuan Gong, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

12540 Issued in CT

Practice address

579 Newfield Ave
Stamford, CT 06905-3302

Phone

(203) 890-9300

Fax

(203) 890-9250

NPI assigned

Jun 16, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Yixuan Gong Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Dulcet Dental Smiles PC

  dba Newfield Dental

  • General Practice Dentistry
  • Stamford, CT
  • NPI 1134774847
  NPD Authorized official
• Concerned Dental Care, PC

  • Dentist
  • South Richmond Hill, NY
  • NPI 1699818997
  NPD (past)

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

{
    "created_epoch": "1434412800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591660800000",
    "number": "1447631486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "579 NEWFIELD AVE",
            "city": "STAMFORD",
            "state": "CT",
            "postal_code": "069053302",
            "telephone_number": "203-890-9300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "579 NEWFIELD AVE",
            "city": "STAMFORD",
            "state": "CT",
            "postal_code": "069053302",
            "telephone_number": "203-890-9300",
            "fax_number": "203-890-9250"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "800 Poly Pl",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "112097104",
            "country_code": "US",
            "telephone_number": "718-836-6600",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "11901 Liberty Ave",
            "address_purpose": "LOCATION",
            "city": "South Richmond Hill",
            "state": "NY",
            "postal_code": "114192001",
            "country_code": "US",
            "telephone_number": "718-843-1616",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GONG",
        "first_name": "AMINA",
        "middle_name": "YIXUAN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-16",
        "last_updated": "2020-06-09",
        "certification_date": "2020-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "058587",
            "primary": false
        },
        {
            "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": "CT",
            "license": "12540",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04803581",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "YIXUAN",
            "last_name": "GONG",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Melissa Klein Goldstein, M.D.
• Jonathan Carlton Goldweitz, M.D.
• Efraim Gomez Zapata, MD
• Olga Goncharova, DDS
• Meryum Gondal, MD
• Heejae Gong
• Logan Nora Destiny Gonsalves, MD
• Amanda Gonzalez-Bunster
• Jacob Allen Gonzalez, PCT, CET, CPT, BLS
• Michelle Fatima Gonzalez, MS. CF-SLP

• Dentist in Stamford, CT
• Providers in Stamford, CT by specialty
• Dentist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2020; 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.