Fun Dental 4 Kids 4

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

FUN DENTAL 4 KIDS 4

Practice address

1000 E Washington Blvd
Los Angeles, CA 90021-3072

Phone

(323) 562-1301

NPI assigned

Feb 7, 2019

Organization subpart

No

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

Authorized official

Name

John Yoo, DDS

Title

President

Phone

(310) 619-5880

Specialties & licenses 1

Addresses

Other names 1

• Fun Dental 4 Kids Doing business as

Locations

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

{
    "created_epoch": "1549497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1549497600000",
    "number": "1972068518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6383 ATLANTIC AVE",
            "city": "BELL",
            "state": "CA",
            "postal_code": "902011227",
            "telephone_number": "323-562-1301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 E WASHINGTON BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900213072",
            "telephone_number": "323-562-1301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FUN DENTAL 4 KIDS 4",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-07",
        "last_updated": "2019-02-07",
        "status": "A",
        "authorized_official_last_name": "YOO",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-619-5880",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fun Dental 4 Kids",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Fullfill, Inc.
• Howard J. Fullman, MD
• Mellisa Fulmer
• Tyequighae Fulton
• Fun Dental 4 Kids 2
• Fun Dental 4 Kids 6
• Functherapy Inc
• Functional Restoration Medical Center, Inc,
• Functional Restoration Medical Center, Inc,
• Fundamental Health Center LLC

• General Practice Dentistry in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2019; 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.