Healthcare Provider Details

I. General information

NPI: 1306475181
Provider Name (Legal Business Name): HY-FUN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2020
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 SE HEARTHWOOD BLVD # 873933
VANCOUVER WA
98684-7551
US

IV. Provider business mailing address

304 SE HEARTHWOOD BLVD # 8739933
VANCOUVER WA
98684-7551
US

V. Phone/Fax

Practice location:
  • Phone: 702-849-3302
  • Fax:
Mailing address:
  • Phone: 503-877-5543
  • Fax: 778-769-4717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BONA BOBO
Title or Position: OWNER
Credential: NP
Phone: 503-877-5543