Jae Young Yoo, DDS, MSD

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

103617 Issued in CA

Practice address

14021 Midland Rd
Poway, CA 92064-3959

Phone

(858) 883-4860

Fax

(858) 883-4845

NPI assigned

Jan 12, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Dr. Ethan Jae-Young Yoo Other name

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

Locations

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.

• Jae Yoo, DDS, MSD, Inc

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Poway, CA
  • NPI 1588303465
  NPD Authorized official
• John C. Nosti, D.D.S. Inc.

  • General Practice Dentistry
  • San Diego, CA
  • NPI 1639566565
  NPD (past)
• Nosti Professional Dental Corporation

  • General Practice Dentistry
  • Escondido, CA
  • NPI 1881922771
  NPD (past)

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

{
    "created_epoch": "1515715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661472000000",
    "number": "1902314834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14021 MIDLAND RD",
            "city": "POWAY",
            "state": "CA",
            "postal_code": "920643959",
            "telephone_number": "858-883-4860",
            "fax_number": "858-883-4845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14021 MIDLAND RD",
            "city": "POWAY",
            "state": "CA",
            "postal_code": "920643959",
            "telephone_number": "858-883-4860",
            "fax_number": "858-883-4845"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "860 W Valley Pkwy Ste 100",
            "address_purpose": "LOCATION",
            "city": "Escondido",
            "state": "CA",
            "postal_code": "920252534",
            "country_code": "US",
            "telephone_number": "760-745-1585",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5965 Village Way Ste E-206",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921302475",
            "country_code": "US",
            "telephone_number": "858-900-3541",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "YOO",
        "first_name": "JAE",
        "middle_name": "YOUNG",
        "name_prefix": "Dr.",
        "credential": "DDS, MSD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-01-12",
        "last_updated": "2022-08-26",
        "certification_date": "2022-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "CO",
            "license": "00203357",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "CA",
            "license": "103617",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ETHAN",
            "last_name": "YOO",
            "middle_name": "JAE-YOUNG",
            "prefix": "DR.",
            "credential": "DDS, MSD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Bihua Yang, OTR/L, MA
• Meizi Yang
• Taliha Yasin, MD
• Cierra Ybanez
• Andrew Chung Ming Yeung, PHARM.D., FASCP
• Casey Ann Young
• Dejah Younger
• Sheldon Blake Zablow, M.D.
• Zaina Zaidan
• Kamen Nikolov Zakov, MD

• Orthodontics and Dentofacial Orthopedics Dentistry in Poway, CA
• Providers in Poway, CA by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2022; 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.