Individual provider Active NPI

Su Joong Yoon, DDS

  • General Practice Dentistry
  • Garden Grove, CA
National Provider Identifier
1457563108
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
26143 Issued in CA
Practice address
9520 Garden Grove Blvd
#14
Garden Grove, CA 92844-1528
Phone
(714) 537-9160
Fax
(714) 839-5077
NPI assigned
May 4, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 26143 CA Primary

Addresses

Primary practice location

9520 Garden Grove Blvd
#14
Garden Grove, CA 92844-1528

Mailing address

9520 Garden Grove Blvd
#14
Garden Grove, CA 92844-1528
Phone (714) 537-9160

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

NPI Registry JSON

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

{
    "created_epoch": "1178236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1457563108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9520 GARDEN GROVE BLVD",
            "address_2": "#14",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928441528",
            "telephone_number": "714-537-9160",
            "fax_number": "714-839-5077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9520 GARDEN GROVE BLVD",
            "address_2": "#14",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928441528",
            "telephone_number": "714-537-9160",
            "fax_number": "714-839-5077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YOON",
        "first_name": "SU",
        "middle_name": "JOONG",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "26143",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Garden Grove, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.

Verify at the official NPI Registry.