Shane Yin Koo, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN30451 Issued in FL

Practice address

9900 Lincoln St 2ND Floor
Tacoma, WA 98431-0001

Phone

(253) 968-4079

NPI assigned

Aug 5, 2025

Last updated

Aug 5, 2025By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1754352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754352000000",
    "number": "1790669406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "930 ROSS LOOP APT D403",
            "city": "DUPONT",
            "state": "WA",
            "postal_code": "983279052",
            "telephone_number": "786-202-5218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9900 LINCOLN ST 2ND FLOOR",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984310001",
            "telephone_number": "253-968-4079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOO",
        "first_name": "SHANE",
        "middle_name": "YIN",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-08-05",
        "last_updated": "2025-08-05",
        "certification_date": "2025-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN30451",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steven Jay Konicek, MD
• Jennifer Ann Koning, LICSW
• Lisa Konitzer, MPT
• Kathleen Konzelman
• Alex Yushaun Koo, MD
• Kelsi Rae Koon, BEHAVIOR TECHNICIAN
• Charles I Koonce, LMHC
• Clyde Harry Koontz, MD
• Alexandra H Koopman, LW61313713
• Sarah Ann Kopaciewicz

• General Practice Dentistry in Tacoma, WA
• Providers in Tacoma, WA by specialty
• General Practice Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2025; 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.