Provider Demographics
NPI:1114978012
Name:MIN, SUNG K (MD)
Entity Type:Individual
Prefix:
First Name:SUNG
Middle Name:K
Last Name:MIN
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 1:3860 RACE RD STE 203
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-4307
Mailing Address - Country:US
Mailing Address - Phone:513-842-7781
Mailing Address - Fax:513-842-7783
Practice Address - Street 1:3860 RACE RD STE 203
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-4307
Practice Address - Country:US
Practice Address - Phone:513-842-7781
Practice Address - Fax:513-842-7783
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35084990208VP0014X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64122294Medicaid
OH616164000OtherUS DEPT OF LABOR
IN201047290AMedicaid
OH2529946Medicaid
IN201047290AMedicaid
G39535Medicare UPIN
OH2529946Medicaid
KY0666705Medicare PIN