Provider Demographics
NPI:1164022216
Name:YAN, JUN
Entity Type:Individual
Prefix:
First Name:JUN
Middle Name:
Last Name:YAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6580 PALMETTO DR
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-7646
Mailing Address - Country:US
Mailing Address - Phone:513-739-4650
Mailing Address - Fax:
Practice Address - Street 1:1143 SMILEY AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45240-1832
Practice Address - Country:US
Practice Address - Phone:513-825-3804
Practice Address - Fax:513-825-3809
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03129544183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist