Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0120X | Pediatric Surgery | 42458 | KY |
Y | 2086S0120X | Pediatric Surgery | MD177023 | OR |
NPI | 1639128499 |
---|---|
Provider Name | Jeannie Yang Chun |
First Address | Portland, OR 97208-3158 |
Second Address | Portland, OR 97225-6652 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2006 |
Last Update Date | 19/02/2021 |