Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 4035 | OR |
NPI | 1104377043 |
---|---|
Provider Name | Sunny Jung |
First Address | Beaverton, OR 97005-3022 |
Second Address | Beaverton, OR 97005-3022 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/10/2016 |
Last Update Date | 15/10/2016 |