Provider Demographics
NPI:1922155563
Name:FOFUNG, SEMA JUSTUS (DO)
Entity Type:Individual
Prefix:MR
First Name:SEMA
Middle Name:JUSTUS
Last Name:FOFUNG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:735 SOUTH SHOOP AVENUE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WAUSEON
Mailing Address - State:OH
Mailing Address - Zip Code:43567
Mailing Address - Country:US
Mailing Address - Phone:419-335-6377
Mailing Address - Fax:419-335-6807
Practice Address - Street 1:735 SOUTH SHOOP AVENUE
Practice Address - Street 2:SUITE 3
Practice Address - City:WAUSEON
Practice Address - State:OH
Practice Address - Zip Code:43567
Practice Address - Country:US
Practice Address - Phone:419-335-6377
Practice Address - Fax:419-335-6807
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34007671174400000X
OH34.007671207V00000X
OH34-007671174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2317479Medicaid
OHH27109Medicare UPIN
OH4085682Medicare PIN