TAE KWON
NPI 1992157572
Dentist - Orthodontics and Dentofacial Orthopedics in Fresno, CA

Active since July 07, 2016PECOS Enrolled
1161 E SHEPHERD AVE APT 201, FRESNO, CA 93720(310) 890-0816 Get Directions Write a Review

NPPES record last updated: July 16, 2019. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Tae Kwon NPPES

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

TAE KWON (NPI 1992157572) is an individual orthodontics and dentofacial orthopedics provider in Fresno, California, licensed in California (103782) and active in the NPI registry since July 2016. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1992157572
Entity TypeIndividualMale
Primary Taxonomy1223X0400X
Provider Legal NameTAE KWON
Location Address1161 E SHEPHERD AVE APT 201Fresno, CA 93720-2046
Mailing Address777 Main St Unit 2404Hartford, CT 06103-2325 · (310) 890-0816
Sole ProprietorNo
Enumeration DateJuly 7, 2016
Last NPPES UpdateJuly 16, 2019
NPI 1992157572 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

Primary SpecialtyDentist · Orthodontics and Dentofacial OrthopedicsDental Providers
Taxonomy Code1223X0400X
License Licensed in CA · 103782
Definition
That area of dentistry concerned with the supervision, guidance and correction of the growing or mature dentofacial structures, including those conditions that require movement of teeth or correction of malrelationships and malformations of their related structures and the adjustment of relationships between and among teeth and facial bones by the application of forces and/or the stimulation and redirection of functional forces within the craniofacial complex. Major responsibilities of orthodontic practice include the diagnosis, prevention, interception and treatment of all forms of malocclusion of the teeth and associated alterations in their surrounding structures; the design, application and control of functional and corrective appliances; and the guidance of the dentition and its supporting structures to attain and maintain optimum occlusal relations in physiologic and esthetic harmony among facial and cranial structures.
1161 E SHEPHERD AVE APT 201, Fresno, CA 93720

Accepted 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)

Tae Kwon 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 93720 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
$90.32 typical visit price
range $58.87 – $176.60
Typical copayment $22.58 (range $14.71 – $44.15)
Most-billed visit code 99203
Established Patient
$73.16 typical visit price
range $19.28 – $144.60
Typical copayment $18.29 (range $4.82 – $36.15)
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.

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 Tae Kwon's NPI number?

The NPI number for Tae Kwon is 1992157572. It was assigned to this individual provider in the NPPES registry on July 7, 2016.

Where is Tae Kwon located?

Tae Kwon practices at 1161 E Shepherd Ave Apt 201, Fresno, CA 93720. The listed phone number is (310) 890-0816.

What is Tae Kwon's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Orthodontics and Dentofacial Orthopedics, with taxonomy code 1223X0400X.

Is Tae Kwon enrolled in Medicare?

Yes. Tae Kwon is registered in the Medicare PECOS enrollment system.

What insurance does Tae Kwon accept?

Health plans from Anthem Blue Cross and Blue Shield, BEST Life, Blue Cross and Blue Shield of Alabama, Blue Cross and Blue Shield of Montana and Blue Cross and Blue Shield of Oklahoma and 5 other insurers list Tae Kwon 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 Tae Kwon was last updated on July 16, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.