Provider Demographics
NPI:1083607444
Name:YUN, JAIMIE (DPM)
Entity Type:Individual
Prefix:
First Name:JAIMIE
Middle Name:
Last Name:YUN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:JAIMIE
Other - Middle Name:
Other - Last Name:YUN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:PO BOX 27940
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43227-0940
Mailing Address - Country:US
Mailing Address - Phone:614-239-0399
Mailing Address - Fax:614-237-5220
Practice Address - Street 1:4698 CEMETERY RD
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-1124
Practice Address - Country:US
Practice Address - Phone:614-771-7100
Practice Address - Fax:614-771-6174
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-00-2835213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0171700Medicaid
OHYU0791814OtherMEDICARE PTAN
OH1048840007Medicare NSC
OHYU0791814OtherMEDICARE PTAN
OHU57970Medicare UPIN
OH1048840001Medicare NSC