Yutdhasak Kjornrattanawanich, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

9427 Issued in CT

Practice address

1128 Farmington Ave
Bristol, CT 06010-4752

Phone

(860) 585-1716

Fax

(860) 585-1758

NPI assigned

Dec 16, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

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

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.

• Aspen Dental of Greater Hartford, PC

  • General Practice Dentistry
  • Bristol, CT
  • NPI 1215154067
  NPD (past) Authorized official

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

{
    "created_epoch": "1166227200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1982766689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3189",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132203189",
            "telephone_number": "315-454-6000",
            "fax_number": "315-454-8650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1128 FARMINGTON AVE",
            "city": "BRISTOL",
            "state": "CT",
            "postal_code": "060104752",
            "telephone_number": "860-585-1716",
            "fax_number": "860-585-1758"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KJORNRATTANAWANICH",
        "first_name": "YUTDHASAK",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CT",
            "license": "9427",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kids Dental Care Anesthesia, LLC
• Kids Dental Care, LLC
• Kim Ann Kim, MSN, APRN, PMHNP-BC
• Charles Malik Kinard
• Kind Attention Behavioral Health LLC
• Kelli Ann Klies, RN
• Melanie Klinck
• Elaine Mary Knowles, RPH
• A.E. Hertzler Knox, MD
• Wing H Ko, D.M.D.

• Dentist in Bristol, CT
• Providers in Bristol, CT by specialty
• Dentist in Connecticut

• 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.

Verify at the official NPI Registry.