NPIMap

Organization Active NPI

Wilmington Dental Group

  • Dentist
  • Wilmington, CA
National Provider Identifier
1649656489
Registry record updated Aug 4, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
61918 Issued in CA
Legal business name
WILMINGTON DENTAL GROUP
Practice address
414 W Pacific Coast Hwy
Wilmington, CA 90744-2524
Phone
(310) 518-3522
NPI assigned
Aug 4, 2015
Last updated
Aug 4, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2015

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

Authorized official

Name
John Yoo
Title
Owner
Phone
(310) 518-3522

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 61938 CA
Dentist 122300000X 61918 CA Primary

Addresses

Primary practice location

414 W Pacific Coast Hwy
Wilmington, CA 90744-2524

Mailing address

414 W Pacific Coast Hwy
Wilmington, CA 90744-2524

National Provider Directory

National Provider Directory
Tax ID family
Fun Dental 4 Kids2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1438646400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1438646400000",
    "number": "1649656489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "414 W PACIFIC COAST HWY",
            "city": "WILMINGTON",
            "state": "CA",
            "postal_code": "907442524"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "414 W PACIFIC COAST HWY",
            "city": "WILMINGTON",
            "state": "CA",
            "postal_code": "907442524",
            "telephone_number": "310-518-3522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILMINGTON DENTAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-04",
        "last_updated": "2015-08-04",
        "status": "A",
        "authorized_official_last_name": "YOO",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "310-518-3522"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "61938",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "61918",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2015; 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.