MEDICARE: ANDREW WUNG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	27154	OR

General Provider Information

NPI Number	:	1871209676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW WUNG

Provider Business Mailing Address
First Line	:	21841 NE LARKSPUR LN
Second Line	:
City	:	FAIRVIEW
State	:	OR
Zip	:	97024-6785
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1617 NE 17TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97232-3561
Country	:	US
Telephone Number	:	503-659-1212
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2023
Last Update Date	:	01/25/2023

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Directions to “ ANDREW WUNG ” Practice Location

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