Active NPI
Keone Tyau
- Dentist
- Winslow, AZ
National Provider Identifier
1790154151
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 50058186
- Practice address
- 500 N Indiana Ave
Winslow, AZ 86004 - Phone
- (928) 289-6116
- NPI assigned
- Sep 16, 2015
- Sex
- Male
- 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 | 50058186 | NY | Primary |
Addresses
Primary practice location
500 N Indiana Ave
Winslow, AZ 86004
Mailing address
500 N Indiana Ave
Winslow, AZ 86004
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 |
|---|---|---|---|
| 50058186 | NY | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1442361600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1442361600000",
"number": "1790154151",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 N INDIANA AVE",
"city": "WINSLOW",
"state": "AZ",
"postal_code": "86004"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 N INDIANA AVE",
"city": "WINSLOW",
"state": "AZ",
"postal_code": "86004",
"telephone_number": "928-289-6116"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TYAU",
"first_name": "KEONE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-09-16",
"last_updated": "2015-09-16",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": "50058186",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Winslow, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 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.