Individual provider Active NPI

Tae Hyun Yoon, M.D.

  • Internal Medicine Physician
  • Milwaukee, WI
National Provider Identifier
1508918178
Registry record updated Dec 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
C161090 Issued in CA
Practice address
5000 W National Ave
Milwaukee, WI 53295-5000
Phone
(414) 384-2000
NPI assigned
Jan 17, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 29, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 36111980 IL
Internal Medicine Physician 207R00000X C161090 CA Primary

Addresses

Primary practice location

5000 W National Ave
Milwaukee, WI 53295-5000

Mailing address

823 Gateway Center Way
San Diego, CA 92102-4541
Phone (619) 515-2300

Other practice location 1

525 E Main St
El Cajon, CA 92020-4007
Phone (619) 515-2498

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210128001600 CA Practitioner - Internal Medicine 5597995407 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Rush Medical College of Rush University, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Family Health Centers of San Diego IncGroup PAC ID 3476446378, 299 clinicians

Practice addresses (Care Compare)

1809 National Ave
San Diego, CA 92113-2113
Phone (619) 515-2300

Hospital & facility affiliations

  • Archer Health Inc Home health agency, Carlsbad, CA, CCN 053124

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
C161090CAMDInternal Medicine Physician
36111980ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Family Health Centers of San Diego Inc CurrentSince Jan 22, 2021 Accepting new patients
Family Health Centers of San Diego, Inc CurrentSince Jan 22, 2021 Accepting new patients
Family Health Centers of San Diego, Inc Current Accepting new patients

Locations

525 E Main St
El Cajon, CA 92020
Phone (619) 334-3787

823 Gateway Center Way
San Diego, CA 92102
Phone (619) 515-2323

1809 National Ave
San Diego, CA 92113
Phone (619) 515-2500

Organizations & group practices 3

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672272000000",
    "number": "1508918178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "823 GATEWAY CENTER WAY",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921024541",
            "telephone_number": "619-515-2300",
            "fax_number": "619-269-0674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5000 W NATIONAL AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532955000",
            "telephone_number": "414-384-2000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "525 E Main St",
            "address_purpose": "LOCATION",
            "city": "El Cajon",
            "state": "CA",
            "postal_code": "920204007",
            "country_code": "US",
            "telephone_number": "619-515-2498",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "YOON",
        "first_name": "TAE HYUN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-17",
        "last_updated": "2022-12-29",
        "certification_date": "2022-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "36111980",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "C161090",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.