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General NPI Number Information
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NPI Number | 1477603504
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Entity Type | Individual
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Provider Name | JONATHAN YOUNG JI M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 12/17/2024
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Provider Practice Location Address
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Address Line | 615 N MICHIGAN ST FL 1
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City | SOUTH BEND
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State | IN
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Zip | 46601-1033
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Country | US
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Telephone | 574-647-1610
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Fax |
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Provider Business Mailing Address
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Address Line | 53842 GENERATIONS DR
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City | SOUTH BEND
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State | IN
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Zip | 46635-1543
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Country | US
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Telephone | 574-647-1069
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Fax | 574-647-6949
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 77177
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 036162049
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 21273
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License Number State | WI
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Taxonomy #4
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 01064532A
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License Number State | IN
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