Provider Demographics
NPI:1407073158
Name:JUN, HEESOON (PHD)
Entity Type:Individual
Prefix:DR
First Name:HEESOON
Middle Name:
Last Name:JUN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 SUNSET BEACH DR NW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-3556
Mailing Address - Country:US
Mailing Address - Phone:360-866-4502
Mailing Address - Fax:
Practice Address - Street 1:3100 SUNSET BEACH DR NW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-3556
Practice Address - Country:US
Practice Address - Phone:360-866-4502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00001144103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR095918000OtherREGENCE OF OREGON
OR140707315801OtherPROVIDENCE HEALTH PLAN
WAJU4714OtherREGENCE
KY140707315801OtherMHN SERVICES
WA210697100000OtherPREMERA
WAJU4714OtherREGENCE