Provider Demographics
NPI:1508899576
Name:AN, HYUNJOON
Entity Type:Individual
Prefix:MR
First Name:HYUNJOON
Middle Name:
Last Name:AN
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 1:681 LANCASTER DR NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-4733
Mailing Address - Country:US
Mailing Address - Phone:503-585-7616
Mailing Address - Fax:503-362-9010
Practice Address - Street 1:681 LANCASTER DR NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-4733
Practice Address - Country:US
Practice Address - Phone:503-585-7616
Practice Address - Fax:503-362-9010
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12873183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist