Basic Information
| Provider Information | |||||||||
| NPI: | 1841498722 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHUNG | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 237 WILLIAM HOWARD TAFT RD | ||||||||
| Address2: | 2ND FL, CBO2-3, ATTN: CREDENTIALING | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452192610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137927441 | ||||||||
| FaxNumber: | 5137914042 | ||||||||
| Practice Location | |||||||||
| Address1: | 9250 BLUE ASH RD | ||||||||
| Address2: | |||||||||
| City: | BLUE ASH | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452426822 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137927445 | ||||||||
| FaxNumber: | 5137914042 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2007 | ||||||||
| LastUpdateDate: | 09/22/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 268967 | NY | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 208100000X | 46125 | KY | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 390200000X | 209100000X | PA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208100000X | 35.121576 | OH | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 94269 | 01 | OH | MEDICAID | OTHER | 7100275100 | 01 | KY | MEDICAID | OTHER | 898704 | 01 | OH | ANTHEM | OTHER | K165100 | 01 | KY | MEDICARE | OTHER | H249981 | 01 | OH | MEDICARE | OTHER | CS1435100163 | 01 | OH | CARESOURCE | OTHER | 50077938 | 01 | OH | PASSPORT HEALTH | OTHER | 1062846 | 01 | KY | WELLCARE | OTHER |