Healthcare Provider Details

I. General information

NPI: 1356413082
Provider Name (Legal Business Name): JIN YUN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 10/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 JEFFERSON ST
EXPORT PA
15632
US

IV. Provider business mailing address

314 JEFFERSON ST
EXPORT PA
15632-9000
US

V. Phone/Fax

Practice location:
  • Phone: 702-579-5205
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15745
License Number StateNV

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: