Active NPI
Jangyeul Yoon, DDS
- General Practice Dentistry
- Fairfax, VA
National Provider Identifier
1538100748
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DS035289
- Practice address
- 10807 Main St Ste 200
Fairfax, VA 22030-4730 - Phone
- (703) 261-6999
- Fax
- (703) 349-2575
- NPI assigned
- Jun 9, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DS035289 | PA | Primary |
Addresses
Primary practice location
10807 Main St Ste 200
Fairfax, VA 22030-4730
Mailing address
10807 Main St Ste 200
Fairfax, VA 22030-4730
Phone (703) 261-6999
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 001900640 | Medicaid | PA | |
| 01388616 | Other | PA | UNITED CONCORDIA |
| 106688 | Other | PA | DENTAL BENEFIT PROVIDERS |
| 132759 | Other | PA | UNISON |
| 0015943 | Other | PA | DORAL DENTAL |
| DS035289 | Other | PA | DELTA DENTAL |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DS035289 | PA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149811200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1224115200000",
"number": "1538100748",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10807 MAIN ST STE 200",
"city": "FAIRFAX",
"state": "VA",
"postal_code": "220304730",
"telephone_number": "703-261-6999",
"fax_number": "703-349-2575"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10807 MAIN ST STE 200",
"city": "FAIRFAX",
"state": "VA",
"postal_code": "220304730",
"telephone_number": "703-261-6999",
"fax_number": "703-349-2575"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YOON",
"first_name": "JANGYEUL",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-09",
"last_updated": "2008-10-16",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "PA",
"license": "DS035289",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "001900640",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA",
"identifier": "01388616",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DENTAL BENEFIT PROVIDERS",
"identifier": "106688",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNISON",
"identifier": "132759",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DORAL DENTAL",
"identifier": "0015943",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DELTA DENTAL",
"identifier": "DS035289",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fairfax, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.