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General NPI Number Information
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NPI Number | 1285523795
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Entity Type | Individual
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Provider Name | YOONTAE JUNG
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Gender | Male
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Dates
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Enumeration Date | 06/30/2025
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Last Update Date | 06/30/2025
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Provider Practice Location Address
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Address Line | 2500 METROHEALTH DR
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City | CLEVELAND
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State | OH
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Zip | 44109-1900
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Country | US
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Telephone | 216-778-7800
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Fax |
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Provider Business Mailing Address
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Address Line | 6871 AMES RD APT 820
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City | PARMA
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State | OH
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Zip | 44129-5837
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Country | US
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Telephone | 718-530-5880
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P0004X
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Taxonomy Name | Spinal Cord Injury Medicine Physician
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License Number | 57.259025
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License Number State | OH
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