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DR. JI MOON SUR DMD
NPI 1174864169
Dentist - General Practice in Dublin, CA

Active since March 15, 2013PECOS Enrolled
5073 PIPER GLEN TER, DUBLIN, CA 94568(215) 275-4585 Get Directions Write a Review

NPPES record last updated: January 18, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Dr. Ji Moon Sur Dmd NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. JI MOON SUR DMD (NPI 1174864169) is an individual general practice provider in Dublin, California, licensed in California (DDS105329) and active in the NPI registry since March 2013. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1174864169
Entity TypeIndividualFemale
Primary Taxonomy1223G0001X
Provider Legal NameDR. JI MOON SURCredential: DMD
Location Address5073 PIPER GLEN TERDublin, CA 94568-7490
Mailing Address6086 Hillbrook PlDublin, CA 94568-7316 · (215) 275-4585
Phone(215) 275-4585
Sole ProprietorYes
Enumeration DateMarch 15, 2013
Last NPPES UpdateJanuary 18, 2024
NPPES CertifiedJanuary 18, 2024
✔ NPI 1174864169 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers
Taxonomy Code1223G0001X
License✔ Licensed in CA · DDS105329
Definition
A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.
5073 PIPER GLEN TER, Dublin, CA 94568
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BEST Life, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Ji Moon Sur Dmd is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 94568 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$104.51 typical visit price
range $69.00 – $202.35
Typical copayment $26.12 (range $17.25 – $50.58)
Most-billed visit code 99203
Established Patient
$84.91 typical visit price
range $23.44 – $166.46
Typical copayment $21.22 (range $5.86 – $41.61)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KENNETH YUEN-JING LO
Physical Therapist
5073 PIPER GLEN TER
DUBLIN, CA 94568
Alameda County (650) 218-2542

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ji Moon Sur's NPI number?

The NPI number for Ji Moon Sur is 1174864169. It was assigned to this individual provider in the NPPES registry on March 15, 2013.

Where is Ji Moon Sur located?

Ji Moon Sur practices at 5073 Piper Glen Ter, Dublin, CA 94568. The listed phone number is (215) 275-4585.

What is Ji Moon Sur's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

Is Ji Moon Sur enrolled in Medicare?

Yes. Ji Moon Sur is registered in the Medicare PECOS enrollment system.

What insurance does Ji Moon Sur accept?

Health plans from BEST Life, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma, Blue Cross and Blue Shield of Texas and HRI Dental & Vision and 3 other insurers list Ji Moon Sur as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Ji Moon Sur was last updated on January 18, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.