Johnny Heejoon Koo, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

52073 Issued in CA

Practice address

40820 Winchester Rd
1500
Temecula, CA 92591-5525

Phone

(951) 296-6788

NPI assigned

Feb 9, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Elias, Elliott, Lampasi, Fehn, & Harris Adp

  • Dentist
  • Temecula, CA
  • NPI 1033286265
  NPD (past)

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

{
    "created_epoch": "1170979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1299024000000",
    "number": "1760523930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40820 WINCHESTER RD",
            "address_2": "SUITE 1500",
            "city": "TEMECULA",
            "state": "CA",
            "postal_code": "925915525",
            "telephone_number": "951-296-6788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40820 WINCHESTER RD",
            "address_2": "1500",
            "city": "TEMECULA",
            "state": "CA",
            "postal_code": "925915525",
            "telephone_number": "951-296-6788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOO",
        "first_name": "JOHNNY",
        "middle_name": "HEEJOON",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-09",
        "last_updated": "2011-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "52073",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Koinonia Foster Homes, Inc.
• Annie Koirala, NP
• Natalie Claire Kolb
• Sruthi Kondakindi, DDS
• Sacho Rade Kondovski, DO
• Janet Okyerewaah Koomson, LVN
• Melanie A Koperovskiy
• Tara Korbal, MD
• Brenda Rose Koreerat
• Caroline Lamb Kornelsen

• General Practice Dentistry in Temecula, CA
• Providers in Temecula, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.