Active NPI
Omar Kenneth Yeung, D.D.S.
- General Practice Dentistry
- Richton Park, IL
National Provider Identifier
1922022375
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 01921790
- Practice address
- 22117 Governors Hwy
Richton Park, IL 60471-1249 - Phone
- (708) 747-6610
- Fax
- (708) 747-6703
- NPI assigned
- Jul 27, 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 | 01921790 | IL | Primary |
Addresses
Primary practice location
22117 Governors Hwy
Richton Park, IL 60471-1249
Mailing address
22117 Governors Hwy
Richton Park, IL 60471-1249
Phone (708) 747-6610
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01921790 | IL | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153958400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1922022375",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22117 GOVERNORS HWY",
"city": "RICHTON PARK",
"state": "IL",
"postal_code": "604711249",
"telephone_number": "708-747-6610",
"fax_number": "708-747-6703"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22117 GOVERNORS HWY",
"city": "RICHTON PARK",
"state": "IL",
"postal_code": "604711249",
"telephone_number": "708-747-6610",
"fax_number": "708-747-6703"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YEUNG",
"first_name": "OMAR",
"middle_name": "KENNETH",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-27",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IL",
"license": "01921790",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Richton Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.