Healthcare Provider Details

I. General information

NPI: 1285523795
Provider Name (Legal Business Name): YOONTAE JUNG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 METROHEALTH DR
CLEVELAND OH
44109-1900
US

IV. Provider business mailing address

6871 AMES RD APT 820
PARMA OH
44129-5837
US

V. Phone/Fax

Practice location:
  • Phone: 216-778-7800
  • Fax:
Mailing address:
  • Phone: 718-530-5880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P0004X
TaxonomySpinal Cord Injury Medicine Physician
License Number57.259025
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: