Healthcare Provider Details

I. General information

NPI: 1588186696
Provider Name (Legal Business Name): JOHN KIM YUNG JR. CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2017
Last Update Date: 04/08/2022
Certification Date: 04/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 N ADOLPH ST
AKRON OH
44304
US

IV. Provider business mailing address

329 SUMMERHILL DR
AURORA OH
44202-8013
US

V. Phone/Fax

Practice location:
  • Phone: 216-513-1085
  • Fax:
Mailing address:
  • Phone: 216-513-1085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number9474005
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0020392
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: