Healthcare Provider Details

I. General information

NPI: 1134416886
Provider Name (Legal Business Name): WESTERN HILLS INTERVENTIONAL PAIN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2011
Last Update Date: 05/01/2018
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

6460 HARRISON AVE SUITE 300
CINCINNATI OH
45247-7957
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 Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number35084990
License Number StateOH

VIII. Authorized Official

Name: SUNG KI MIN
Title or Position: MD/OWNER
Credential: MD
Phone: 513-842-7781