Active NPI
Kenneth M Yip-Young, D.D.S.
- General Practice Dentistry
- Palm Bay, FL
National Provider Identifier
1912086034
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DN15342
- Practice address
- 3440 Bayside Lakes Blvd SE
Suite 1
Palm Bay, FL 32909-6843 - Phone
- (321) 768-0330
- NPI assigned
- Nov 2, 2006
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DN15342 | FL | Primary |
Addresses
Primary practice location
3440 Bayside Lakes Blvd SE
Suite 1
Palm Bay, FL 32909-6843
Mailing address
3440 Bayside Lakes Blvd SE
Suite 1
Palm Bay, FL 32909-6843
Phone (321) 768-0330
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 |
|---|---|---|---|
| DN15342 | FL | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162425600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1204675200000",
"number": "1912086034",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3440 BAYSIDE LAKES BLVD SE",
"address_2": "SUITE 1",
"city": "PALM BAY",
"state": "FL",
"postal_code": "329096843",
"telephone_number": "321-768-0330"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3440 BAYSIDE LAKES BLVD SE",
"address_2": "SUITE 1",
"city": "PALM BAY",
"state": "FL",
"postal_code": "329096843",
"telephone_number": "321-768-0330"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YIP-YOUNG",
"first_name": "KENNETH",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-02",
"last_updated": "2008-03-05",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "FL",
"license": "DN15342",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Palm Bay, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.