Patrick Keone Miyamasu, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

019028007 Issued in IL

Practice address

3210 W 63Rd St
Chicago, IL 60629-3325

Phone

(773) 776-8300

NPI assigned

Jun 29, 2009

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• The Dental Clinic, LLC

  • General Practice Dentistry
  • Chicago, IL
  • NPI 1538330527
  NPD (past)

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

{
    "created_epoch": "1246233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1246233600000",
    "number": "1992933915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3210 W 63RD ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606293325",
            "telephone_number": "773-776-8300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3210 W 63RD ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606293325",
            "telephone_number": "773-776-8300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIYAMASU",
        "first_name": "PATRICK",
        "middle_name": "KEONE",
        "name_prefix": "Mr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-06-29",
        "last_updated": "2009-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019028007",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mikayla Cristine Mix, OTD, OTR/L
• Morgan Gabrielle Mix, M.S., BCABA
• Mary K Mixan, DPT
• Miriam A Mixon, LCSW
• Eriko Miyake
• Ingrid Miyar-Franca
• Mariah Miyat, DNP, FNP
• Rylan Miyat, CSFA, CSA, SA-C, RSA
• Sarah Miyata, NP
• Kyle Miyazaki, MD

• Dentist in Chicago, IL
• Providers in Chicago, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2009; 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.