Provider Demographics
NPI:1508191537
Name:FUNK, JUM THU (ND, MPH)
Entity Type:Individual
Prefix:MRS
First Name:JUM
Middle Name:THU
Last Name:FUNK
Suffix:
Gender:F
Credentials:ND, MPH
Other - Prefix:MISS
Other - First Name:TRAN
Other - Middle Name:THU
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ND, MPH
Mailing Address - Street 1:2626 1/2 BIRCHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1402
Mailing Address - Country:US
Mailing Address - Phone:206-631-9659
Mailing Address - Fax:
Practice Address - Street 1:1810 BROADWAY STREET
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225
Practice Address - Country:US
Practice Address - Phone:360-738-7654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-08
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT00001641175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath