Kiram Yeo Tung, DMD
Individual provider Active NPI Dentist · Ganado, AZ
NPI 1497638175 · NPPES record last updated Jul 29, 2025
Key facts
- NPI
- 1497638175
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- D012492 (AZ)
- Practice address
- 191 Az-264
Ganado, AZ 86505 - Phone
- (928) 755-4861
- NPI assigned
- Jul 29, 2025
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Dentist
- Education
- At Still University, Arizona School of Dentistry & Oral HLTH, 2025
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
PO Box
Suite 457
Ganado, AZ 86505
PO Box
Suite 457
Ganado, AZ 86505-0457
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20251002001860 | AZ | Practitioner - Dentist | 4183120785 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Navajo Health Foundation-Sage Memorial Hospital, Inc. | Current |
Accepting new patients | |
| Navajo Health Foundation-Sage Memorial Hospital Inc | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D012492 | AZ | Yes |
Addresses
Primary practice location
191 Az-264
Ganado, AZ 86505
Mailing address
830 S Winthrop Cir
Mesa, AZ 85204-4633
Phone (602) 321-6549
Other providers in Ganado, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 29, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.