Provider Demographics
NPI:1104377043
Name:JUNG, SUNNY (DMD, ND)
Entity Type:Individual
Prefix:
First Name:SUNNY
Middle Name:
Last Name:JUNG
Suffix:
Gender:F
Credentials:DMD, ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4525 SW 109TH AVE
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-3022
Mailing Address - Country:US
Mailing Address - Phone:971-804-0150
Mailing Address - Fax:
Practice Address - Street 1:4525 SW 109TH AVE
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-3022
Practice Address - Country:US
Practice Address - Phone:971-804-0150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-15
Last Update Date:2016-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4035175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath