Healthcare Provider Details

I. General information

NPI: 1932157070
Provider Name (Legal Business Name): MICHAEL SUNGHUN YI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 12/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 RED BANK RD STE 200
CINCINNATI OH
45227-2177
US

IV. Provider business mailing address

237 WILLIAM HOWARD TAFT RD FL 2
CINCINNATI OH
45219-2610
US

V. Phone/Fax

Practice location:
  • Phone: 513-564-3822
  • Fax: 513-564-3824
Mailing address:
  • Phone: 513-263-8551
  • Fax: 513-366-4480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35-076739
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35-076739
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: