Provider Demographics
NPI:1912032434
Name:YOUN, BRIAN ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:ALLEN
Last Name:YOUN
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 1:821 S SCOTT RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46814-9398
Mailing Address - Country:US
Mailing Address - Phone:260-436-4428
Mailing Address - Fax:
Practice Address - Street 1:821 S SCOTT RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46814-9398
Practice Address - Country:US
Practice Address - Phone:260-414-8449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2016-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01045337A207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200155350Medicaid
INP00465486OtherRAILROAD MEDICARE
IN000000524646OtherANTHEM
IN200155350Medicaid
IN000000524646OtherANTHEM
070860AAAMedicare PIN
IN150640KKKMedicare PIN