Healthcare Provider Details

I. General information

NPI: 1477948628
Provider Name (Legal Business Name): SUJEN KAYLEE KUNUGIYAMA CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2015
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 NE MULTNOMAH ST SUITE 100
PORTLAND OR
97232-2023
US

IV. Provider business mailing address

500 NE MULTNOMAH ST SUITE 100
PORTLAND OR
97232-2023
US

V. Phone/Fax

Practice location:
  • Phone: 503-813-3860
  • Fax:
Mailing address:
  • Phone: 503-813-3860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number200541558RN
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberNUR-RN-LIC-91351
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60306187
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number201503389CRNA-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: