Provider Demographics
NPI:1912929100
Name:REN, JUNLONG (MD)
Entity Type:Individual
Prefix:DR
First Name:JUNLONG
Middle Name:
Last Name:REN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8433 CRATER LAKE HIGH WAY
Mailing Address - Street 2:APT C, BOX # 9
Mailing Address - City:WHITE CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97503
Mailing Address - Country:US
Mailing Address - Phone:541-826-5076
Mailing Address - Fax:541-826-5076
Practice Address - Street 1:8433 CRATER LAKE HIGH WAY
Practice Address - Street 2:APT C, BOX # 9
Practice Address - City:WHITE CITY
Practice Address - State:OR
Practice Address - Zip Code:97503-3036
Practice Address - Country:US
Practice Address - Phone:541-826-5076
Practice Address - Fax:541-826-5076
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA82445208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH84684Medicare UPIN
CA00A824450Medicare ID - Type Unspecified