Healthcare Provider Details

I. General information

NPI: 1831359793
Provider Name (Legal Business Name): JENNIFER ANN JEUNG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2008
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451 EDISON BLVD STE A
TWINSBURG OH
44087-2340
US

IV. Provider business mailing address

2451 EDISON BLVD STE A
TWINSBURG OH
44087-2340
US

V. Phone/Fax

Practice location:
  • Phone: 440-703-2100
  • Fax: 440-210-4549
Mailing address:
  • Phone: 440-703-2100
  • Fax: 440-210-4549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number35.098979
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number22011
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number4301507610
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberD0073515
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: