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General NPI Number Information
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NPI Number | 1538392667
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Entity Type | Organization
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Legal Business Name | EUNSUN LEW, A DENTAL CORPORATION
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Dates
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Enumeration Date | 08/24/2009
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Last Update Date | 11/04/2009
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Provider Practice Location Address
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Address Line | 6614 E MILL PLAIN BLVD
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City | VANCOUVER
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State | WA
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Zip | 98661-7458
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Country | US
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Telephone | 360-696-0471
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Fax | 360-696-0472
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Provider Business Mailing Address
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Address Line | 6614 E MILL PLAIN BLVD
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City | VANCOUVER
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State | WA
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Zip | 98661-7458
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Country | US
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Telephone | 360-696-0471
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Fax | 360-696-0472
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EUNSUN LEW
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Credential | D.D.S.
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Telephone | 360-696-0471
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DE 60028784
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License Number State | WA
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