Provider Demographics
NPI:1568671113
Name:JIN, RYAN YOUNG (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:YOUNG
Last Name:JIN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SEAGATE # 800
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1558
Mailing Address - Country:US
Mailing Address - Phone:517-265-0292
Mailing Address - Fax:517-265-9220
Practice Address - Street 1:717 KIMOLE LANE
Practice Address - Street 2:# 130
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221
Practice Address - Country:US
Practice Address - Phone:517-265-0292
Practice Address - Fax:517-265-9220
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0916032085R0001X
MI43010818532085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2849681Medicaid
OHP00727166OtherRR MEDICARE
MIP00972313OtherRR MEDICARE
MI158671113Medicaid
OHP00727166OtherRR MEDICARE
OHJI4238811Medicare PIN