MEDICARE: DA ONE GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1649883786
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DA ONE GROUP

Provider Business Mailing Address
First Line	:	833 LORD CREWE ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89138-6035
Country	:	US
Telephone Number	:	702-503-8683
Fax Number	:

Provider Business Practice Location Address
First Line	:	9850 S MARYLAND PKWY STE 3
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89183-7148
Country	:	US
Telephone Number	:	702-503-7673
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. YOONJI AN
Credential	:	DMD
Telephone Number	:	702-503-8683

Provider Enumeration Date	:	08/28/2020
Last Update Date	:	08/28/2020

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Directions to “DA ONE GROUP ” Practice Location

Language	Start Address	Practice Location

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