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General NPI Number Information
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NPI Number | 1205928371
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Entity Type | Individual
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Provider Name | TERRESA SHAO-VING JUNG MD
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Gender | Female
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 11/12/2020
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Provider Practice Location Address
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Address Line | 800 SW 13TH AVE
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City | PORTLAND
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State | OR
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Zip | 97205
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Country | US
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Telephone | 503-221-0161
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Fax | 503-274-1697
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Provider Business Mailing Address
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Address Line | 800 SW 13TH AVE
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City | PORTLAND
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State | OR
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Zip | 97205
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Country | US
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Telephone | 503-221-0161
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Fax | 503-274-1697
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | MD21666
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License Number State | OR
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