Provider Demographics
NPI:1417008517
Name:WU, JUNE KWAN (MD)
Entity Type:Individual
Prefix:
First Name:JUNE
Middle Name:KWAN
Last Name:WU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 NE DIVISION ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-5813
Mailing Address - Country:US
Mailing Address - Phone:503-661-4200
Mailing Address - Fax:503-666-0566
Practice Address - Street 1:2150 NE DIVISION ST
Practice Address - Street 2:SUITE 103
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-5813
Practice Address - Country:US
Practice Address - Phone:503-661-4200
Practice Address - Fax:503-666-0566
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD17181208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR038427Medicaid
OR038427Medicaid