Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 30.021662 | OH |
NPI | 1114141793 |
---|---|
Provider Name | Dr. Jason P Yanich |
First Address | Marion, OH 43302-7422 |
Second Address | Marion, OH 43302-7422 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2007 |
Last Update Date | 15/10/2009 |