Provider Demographics
NPI:1336495175
Name:CHEUN, SOMSAY L (LMT)
Entity Type:Individual
Prefix:
First Name:SOMSAY
Middle Name:L
Last Name:CHEUN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 NW 168TH PL
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-8069
Mailing Address - Country:US
Mailing Address - Phone:503-851-0623
Mailing Address - Fax:503-617-0949
Practice Address - Street 1:17200 NW CORRIDOR CT
Practice Address - Street 2:SUITE 100
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-3295
Practice Address - Country:US
Practice Address - Phone:503-851-0623
Practice Address - Fax:503-617-0949
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-30
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR19023225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist