Provider Demographics
NPI:1114345311
Name:POLDEMANN, JENNA JUN (MD)
Entity type:Individual
Prefix:DR
First Name:JENNA
Middle Name:JUN
Last Name:POLDEMANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JENNA
Other - Middle Name:MIN KYUM
Other - Last Name:JUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 750243
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45475-0243
Mailing Address - Country:US
Mailing Address - Phone:937-709-5051
Mailing Address - Fax:937-709-5050
Practice Address - Street 1:1 WYOMING ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-2722
Practice Address - Country:US
Practice Address - Phone:937-208-5642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-03
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.1347352085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology