Healthcare Provider Details

I. General information

NPI: 1073855458
Provider Name (Legal Business Name): SOOHWAN CHUN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2013
Last Update Date: 09/13/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6949 GOOD SAMARITAN DR STE 230
CINCINNATI OH
45247-5205
US

IV. Provider business mailing address

6949 GOOD SAMARITAN DR STE 230
CINCINNATI OH
45247-5205
US

V. Phone/Fax

Practice location:
  • Phone: 513-853-9250
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD467129
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number35.145680
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: