Provider Demographics
NPI:1366478695
Name:YOON, RUTH HANSHIN (DO)
Entity Type:Individual
Prefix:DR
First Name:RUTH
Middle Name:HANSHIN
Last Name:YOON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:4265 OKEMOS RD
Mailing Address - Street 2:SUITE H
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-3285
Mailing Address - Country:US
Mailing Address - Phone:517-349-3444
Mailing Address - Fax:517-349-4330
Practice Address - Street 1:4265 OKEMOS RD
Practice Address - Street 2:SUITE H
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-3285
Practice Address - Country:US
Practice Address - Phone:517-349-3444
Practice Address - Fax:517-349-4330
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101012633207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI01-70260OtherPHP-MEDICAID
MI5032644OtherAETNA US HEALTH
MI080179257OtherRAILROAD/MEDICARE
MI4351381Medicaid
MI5330199OtherBCBS
MI01-01940OtherPHP
MIP96089OtherBCN
MI4351381Medicaid
MI5032644OtherAETNA US HEALTH