Active NPI
Jeong H Son, D.D.S.
- General Practice Dentistry
- Fairfield, CA
National Provider Identifier
1962514695
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 49996
- Practice address
- 1363 Oliver Rd
Suite a
Fairfield, CA 94534-3470 - Phone
- (707) 429-1708
- Fax
- (707) 429-1794
- NPI assigned
- Aug 31, 2006
- Last updated
- Jan 5, 2015
- Sex
- Male
- Sole proprietor
- No
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 | 49996 | CA | Primary |
Addresses
Primary practice location
1363 Oliver Rd
Suite a
Fairfield, CA 94534-3470
Mailing address
1363 Oliver Rd
Suite a
Fairfield, CA 94534-3470
Phone (707) 429-1708
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 20-3314042 | Other | TAX ID |
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 |
|---|---|---|---|
| 49996 | CA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| J.H.Son, DDS, Apc | General Practice | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba New Millennium Dentistry
- General Practice Dentistry
- Fairfield, CA
- NPI 1669534038
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1420416000000",
"number": "1962514695",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1363 OLIVER RD",
"address_2": "SUITE A",
"city": "FAIRFIELD",
"state": "CA",
"postal_code": "945343470",
"telephone_number": "707-429-1708",
"fax_number": "707-429-1794"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1363 OLIVER RD",
"address_2": "SUITE A",
"city": "FAIRFIELD",
"state": "CA",
"postal_code": "945343470",
"telephone_number": "707-429-1708",
"fax_number": "707-429-1794"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SON",
"first_name": "JEONG",
"middle_name": "H",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-31",
"last_updated": "2015-01-05",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "49996",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX ID",
"identifier": "20-3314042",
"state": null
}
],
"endpoints": [],
"other_names": []
}
Other providers in Fairfield, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 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.