Healthcare Provider Details

I. General information

NPI: 1841752045
Provider Name (Legal Business Name): JAE MIN YIM DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2019
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2702 NAVARRE AVE STE 210
OREGON OH
43616-3224
US

IV. Provider business mailing address

2702 NAVARRE AVE STE 102
OREGON OH
43616-3224
US

V. Phone/Fax

Practice location:
  • Phone: 419-696-7000
  • Fax: 419-696-7015
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number34.018046
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: