Healthcare Provider Details

I. General information

NPI: 1114978012
Provider Name (Legal Business Name): SUNG K MIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3860 RACE RD STE 203
CINCINNATI OH
45211-4307
US

IV. Provider business mailing address

3860 RACE RD STE 203
CINCINNATI OH
45211-4307
US

V. Phone/Fax

Practice location:
  • Phone: 513-842-7781
  • Fax: 513-842-7783
Mailing address:
  • Phone: 513-842-7781
  • Fax: 513-842-7783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number35084990
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number35084990
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: