Healthcare Provider Details

I. General information

NPI: 1124054713
Provider Name (Legal Business Name): YANA KHOLODENKO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 10/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7825 LAUREL AVE
CINCINNATI OH
45243-2608
US

IV. Provider business mailing address

7825 LAUREL AVE
CINCINNATI OH
45243-2608
US

V. Phone/Fax

Practice location:
  • Phone: 513-561-4811
  • Fax: 513-561-2730
Mailing address:
  • Phone: 513-561-4811
  • Fax: 513-561-2730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35086773
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: