Active NPI
Pema Youdon
- Dentist
- Columbia Heights, MN
National Provider Identifier
1649950130
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D14982
- Practice address
- 1019 43Rd Ave NE
Columbia Heights, MN 55421-3028 - Phone
- (763) 300-2848
- NPI assigned
- Jul 20, 2023
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Dentist | 122300000X | D14982 | MN | Primary |
Addresses
Primary practice location
1019 43Rd Ave NE
Columbia Heights, MN 55421-3028
Mailing address
1019 43Rd Ave NE
Columbia Heights, MN 55421-3028
Phone (763) 300-2848
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 |
|---|---|---|---|
| D14982 | MN | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1689811200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1689811200000",
"number": "1649950130",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1019 43RD AVE NE",
"city": "COLUMBIA HEIGHTS",
"state": "MN",
"postal_code": "554213028",
"telephone_number": "763-300-2848"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1019 43RD AVE NE",
"city": "COLUMBIA HEIGHTS",
"state": "MN",
"postal_code": "554213028",
"telephone_number": "763-300-2848"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YOUDON",
"first_name": "PEMA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-07-20",
"last_updated": "2023-07-20",
"certification_date": "2023-07-20",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MN",
"license": "D14982",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Columbia Heights, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.