Provider Demographics
NPI:1992708556
Name:JUNG, SIMON C (MD)
Entity type:Individual
Prefix:DR
First Name:SIMON
Middle Name:C
Last Name:JUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10506A MONTGOMERY RD
Mailing Address - Street 2:STE 301
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-4401
Mailing Address - Country:US
Mailing Address - Phone:513-246-2400
Mailing Address - Fax:513-985-2905
Practice Address - Street 1:10506A MONTGOMERY RD
Practice Address - Street 2:STE 301
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-4401
Practice Address - Country:US
Practice Address - Phone:513-246-2400
Practice Address - Fax:513-985-2905
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35078324J207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2197895Medicaid
OHJU4024048Medicare PIN
OHJU4024042Medicare ID - Type Unspecified
OH4024043Medicare PIN
OH2197895Medicaid
OH060070730Medicare PIN
OH4024047Medicare PIN