Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DTDO918828 | OR |
NPI | 1558577007 |
---|---|
Provider Name | Mr. Eui Young Suk |
First Address | Portland, OR 97220-4532 |
Second Address | Portland, OR 97220-4532 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
069168 | (05) | OR |