Provider Demographics
NPI:1912902560
Name:YI, JEAN K (MD)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:K
Last Name:YI
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 1:407 LONGVIEW DR
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-3879
Mailing Address - Country:US
Mailing Address - Phone:610-429-0693
Mailing Address - Fax:
Practice Address - Street 1:407 LONGVIEW DR
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-3879
Practice Address - Country:US
Practice Address - Phone:610-429-0693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-19
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-063373-L174400000X
PA063373L2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAH19967Medicare UPIN
PA049932Medicare ID - Type Unspecified