Healthcare Provider Details

I. General information

NPI: 1184358822
Provider Name (Legal Business Name): JIM YANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2022
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3609 WARSAW AVE
CINCINNATI OH
45205-1721
US

IV. Provider business mailing address

3609 WARSAW AVE
CINCINNATI OH
45205-1721
US

V. Phone/Fax

Practice location:
  • Phone: 513-598-7890
  • Fax:
Mailing address:
  • Phone: 513-374-8782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03441862
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: