1588977912 NPI number — DR. JESSICA AMIE KAFFENBERGER M.D.

Table of content: DR. JESSICA AMIE KAFFENBERGER M.D. (NPI 1588977912)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588977912 NPI number — DR. JESSICA AMIE KAFFENBERGER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KAFFENBERGER
Provider First Name:
JESSICA
Provider Middle Name:
AMIE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
YANKURA
Provider Other First Name:
JESSICA
Provider Other Middle Name:
AMIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1588977912
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/02/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
700 ACKERMAN RD STE 2120
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43202-1559
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-293-1707
Provider Business Mailing Address Fax Number:
614-293-1716

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
540 OFFICE CENTER PL
Provider Second Line Business Practice Location Address:
SUITE 240
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43230-5317
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-293-1707
Provider Business Practice Location Address Fax Number:
614-293-1716
Provider Enumeration Date:
07/14/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  35123270 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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