Provider Demographics
NPI:1275528010
Name:YOUNG, JENNIFER HWEI-TAN (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:HWEI-TAN
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 TAYLOR STATION RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-4400
Mailing Address - Country:US
Mailing Address - Phone:614-866-9134
Mailing Address - Fax:614-866-6964
Practice Address - Street 1:245 TAYLOR STATION RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-4400
Practice Address - Country:US
Practice Address - Phone:614-866-9134
Practice Address - Fax:614-866-6964
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.066621207W00000X
OH35066621207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH043149062-00OtherBWC
OH180031214OtherMEDICARE RAILROAD
OH668809847OtherMEDICAL MUTUAL OF OHIO
OH000000117459OtherANTHEM BC BS
OH0968823Medicaid
OHY00761962Medicare ID - Type Unspecified
OH0968823Medicaid
OHF27930Medicare UPIN