Basic Information
| Provider Information | |||||||||
| NPI: | 1477783371 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PRUDEN | ||||||||
| FirstName: | YOUNG-MI | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 449 | ||||||||
| Address2: | |||||||||
| City: | MARIETTA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457500449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403744500 | ||||||||
| FaxNumber: | 7403745887 | ||||||||
| Practice Location | |||||||||
| Address1: | 401 MATTHEW ST | ||||||||
| Address2: | |||||||||
| City: | MARIETTA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45750 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403761994 | ||||||||
| FaxNumber: | 7403761940 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2009 | ||||||||
| LastUpdateDate: | 08/31/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RS0012X | 35.121720 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine | 207L00000X | 35.121720 | OH | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.