Provider Demographics
NPI:1063406031
Name:YUNKUN, JEFFREY ALLAN (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ALLAN
Last Name:YUNKUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E LIBERTY ST STE 800
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1428
Mailing Address - Country:US
Mailing Address - Phone:502-587-4404
Mailing Address - Fax:502-540-3730
Practice Address - Street 1:225 ABRAHAM FLEXNER WAY
Practice Address - Street 2:2ND FLOOR
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1882
Practice Address - Country:US
Practice Address - Phone:502-587-4799
Practice Address - Fax:502-540-3730
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY28303207L00000X
IN01061554A207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100345590Medicaid
KY64283039Medicaid
KY64283039Medicaid
KY0609088Medicare Oscar/Certification
E82502Medicare UPIN