Provider Demographics
NPI:1366841785
Name:YOON, TAE
Entity Type:Individual
Prefix:
First Name:TAE
Middle Name:
Last Name:YOON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21320 SW LANGER FARMS PARKWAY
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140
Mailing Address - Country:US
Mailing Address - Phone:503-825-4053
Mailing Address - Fax:503-825-4054
Practice Address - Street 1:21320 SW LANGER FARMS PARKWAY
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140
Practice Address - Country:US
Practice Address - Phone:503-825-4053
Practice Address - Fax:503-825-4054
Is Sole Proprietor?:No
Enumeration Date:2014-08-21
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0013806183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist