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General NPI Number Information
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NPI Number | 1790372126
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Entity Type | Individual
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Provider Name | BYUNGRYE JUNG
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Gender | Male
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Dates
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Enumeration Date | 12/31/2020
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Last Update Date | 12/31/2020
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Provider Practice Location Address
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Address Line | 9009 SW HALL BLVD
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City | TIGARD
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State | OR
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Zip | 97223-4432
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Country | US
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Telephone | 503-639-3446
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Fax |
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Provider Business Mailing Address
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Address Line | 19705 SW BOONES FERRY RD APT 1
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City | TUALATIN
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State | OR
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Zip | 97062-9449
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Country | US
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Telephone | 617-775-8336
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Fax |
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH-0017463
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License Number State | OR
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