MEDICARE: KEION NAM YOO DDS

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	1223G0001X	General Practice Dentistry	109420	CA
2	122300000X	Dentist	109420	CA

General Provider Information

NPI Number	:	1316724198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEION NAM YOO DDS

Provider Business Mailing Address
First Line	:	120 E WISTARIA AVE
Second Line	:
City	:	ARCADIA
State	:	CA
Zip	:	91006-4674
Country	:	US
Telephone Number	:	707-339-3653
Fax Number	:

Provider Business Practice Location Address
First Line	:	3761 MALL VIEW RD
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93306-3048
Country	:	US
Telephone Number	:	661-495-5535
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2023
Last Update Date	:	09/13/2023

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