Provider Demographics
NPI:1477603504
Name:JI, JONATHAN YOUNG (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:YOUNG
Last Name:JI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1 JARRETT WHITE RD
Mailing Address - Street 2:TRIPLER ARMY MEDICAL CENTER
Mailing Address - City:TRIPLER ARMY MEDICAL CENTER
Mailing Address - State:HI
Mailing Address - Zip Code:96859-5001
Mailing Address - Country:US
Mailing Address - Phone:808-433-5714
Mailing Address - Fax:808-433-7457
Practice Address - Street 1:1 JARRETT WHITE RD
Practice Address - Street 2:TRIPLER ARMY MEDICAL CENTER
Practice Address - City:TRIPLER ARMY MEDICAL CENTER
Practice Address - State:HI
Practice Address - Zip Code:96859-5001
Practice Address - Country:US
Practice Address - Phone:808-433-5714
Practice Address - Fax:808-433-7457
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2023-05-19
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Provider Licenses
StateLicense IDTaxonomies
WI771772084N0400X
WI212732084N0400X
IL0361620492084N0400X
IN01064532A2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100181475Medicaid