Basic Information
Provider Information
NPI: 1417360694
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: YUN
FirstName: AZIZA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 300 HIGH ST FL 3
Address2:  
City: HAMILTON
State: OH
PostalCode: 450116078
CountryCode: US
TelephoneNumber: 5134541460
FaxNumber:  
Practice Location
Address1: 903 NW WASHINGTON BLVD STE A
Address2:  
City: HAMILTON
State: OH
PostalCode: 450136367
CountryCode: US
TelephoneNumber: 5134541111
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/05/2014
LastUpdateDate: 03/22/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/22/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XAPRN.CNP.0029952OHY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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