Provider Demographics
NPI:1972506418
Name:YOON, JIP J (MD)
Entity Type:Individual
Prefix:DR
First Name:JIP
Middle Name:J
Last Name:YOON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 N JOHN F KENNEDY AVE
Mailing Address - Street 2:
Mailing Address - City:LOOGOOTEE
Mailing Address - State:IN
Mailing Address - Zip Code:47553-1219
Mailing Address - Country:US
Mailing Address - Phone:812-295-2380
Mailing Address - Fax:812-295-2215
Practice Address - Street 1:404 N JOHN F KENNEDY AVE
Practice Address - Street 2:
Practice Address - City:LOOGOOTEE
Practice Address - State:IN
Practice Address - Zip Code:47553-1219
Practice Address - Country:US
Practice Address - Phone:812-295-2380
Practice Address - Fax:812-295-2215
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-28
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01038083207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN311066904OtherFEDERAL TAX ID NO
IN100159120Medicaid
IN100159120Medicaid
IND31285Medicare UPIN