Individual provider Active NPI

Kyunghee K Yoo

  • Dentist
  • Fremont, CA
National Provider Identifier
1720064603
Registry record updated Feb 19, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
58616 Issued in CA
Practice address
38012 Martha Ave
Fremont, CA 94536-3809
Phone
(510) 894-3123
Fax
(510) 894-3503
NPI assigned
Dec 21, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 2901018183 MI
Dentist 122300000X 58616 CA Primary

Addresses

Primary practice location

38012 Martha Ave
Fremont, CA 94536-3809

Mailing address

38012 Martha Ave
Fremont, CA 94536-3809
Phone (510) 894-3123

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
2901018183MIMDGeneral Practice Dentistry
58616CAMDPharmacist

NPI Registry JSON

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

{
    "created_epoch": "1135123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1424304000000",
    "number": "1720064603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "38012 MARTHA AVE",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945363809",
            "telephone_number": "510-894-3123",
            "fax_number": "510-894-3503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "38012 MARTHA AVE",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945363809",
            "telephone_number": "510-894-3123",
            "fax_number": "510-894-3503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YOO",
        "first_name": "KYUNGHEE",
        "middle_name": "K",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-21",
        "last_updated": "2015-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901018183",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "58616",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fremont, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 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.