Jason Chan Yick, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

D14183 Issued in MN

Practice address

9630 Grove Cir N Ste 102
Maple Grove, MN 55369-3480

Phone

(763) 420-5484

NPI assigned

May 15, 2019

Last updated

Jun 26, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Northland Dental Partners, PLLC

  dba Metro Dentalcare Maple Grove Grove Circle

  • General Practice Dentistry
  • Maple Grove, MN
  • NPI 1689324311
  NPD (past)

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

{
    "created_epoch": "1557878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561507200000",
    "number": "1528624566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9630 GROVE CIR N STE 102",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553693480",
            "telephone_number": "612-356-0289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9630 GROVE CIR N STE 102",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553693480",
            "telephone_number": "763-420-5484"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YICK",
        "first_name": "JASON",
        "middle_name": "CHAN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-05-15",
        "last_updated": "2019-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "D14183",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Maple Grove, MN
• Providers in Maple Grove, MN by specialty
• Dentist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2019; 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.