Individual provider Active NPI

John Boram Won, DDS

  • Prosthodontics
  • Loma Linda, CA
National Provider Identifier
1700036266
Registry record updated Sep 22, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
ProsthodonticsTaxonomy code 1223P0700X
License
55828 Issued in CA
Practice address
11092 Anderson Street
Llu School of Dentistry
Loma Linda, CA 92350-0001
Phone
(909) 558-4613
Fax
(909) 558-4192
NPI assigned
Sep 22, 2008
Last updated
Sep 22, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Prosthodontics 1223P0700X 55828 CA Primary

Addresses

Primary practice location

11092 Anderson Street
Llu School of Dentistry
Loma Linda, CA 92350-0001

Mailing address

11092 Anderson Street
Llu School of Dentistry
Loma Linda, CA 92350-0001
Phone (909) 558-4613

Other identifiers 1

IdentifierTypeStateIssuer
55828OtherCASTATE LICENSE

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

LicenseStateTypeSpecialty
55828CAMDProsthodontist

Interoperability endpoints

  • Direct secure messaging: jwon1262754@direct.llu.edu

NPI Registry JSON

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

{
    "created_epoch": "1222041600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1222041600000",
    "number": "1700036266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11092 ANDERSON STREET",
            "address_2": "LLU SCHOOL OF DENTISTRY",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923500001",
            "telephone_number": "909-558-4613",
            "fax_number": "909-558-4192"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11092 ANDERSON STREET",
            "address_2": "LLU SCHOOL OF DENTISTRY",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923500001",
            "telephone_number": "909-558-4613",
            "fax_number": "909-558-4192"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WON",
        "first_name": "JOHN",
        "middle_name": "BORAM",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-09-22",
        "last_updated": "2008-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "CA",
            "license": "55828",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "55828",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Loma Linda, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 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.

Verify at the official NPI Registry.