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General NPI Number Information
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NPI Number | 1871864603
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Entity Type | Organization
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Legal Business Name | CORNELL URGENT CARE
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Dates
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Enumeration Date | 01/25/2012
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Last Update Date | 01/25/2012
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Provider Practice Location Address
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Address Line | 12325 SW HORIZON BLVD UNIT 225
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City | BEAVERTON
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State | OR
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Zip | 97007-9474
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Country | US
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Telephone | 503-747-0120
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Fax |
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Provider Business Mailing Address
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Address Line | 12325 SW HORIZON BLVD UNIT 225
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City | BEAVERTON
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State | OR
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Zip | 97007-9474
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Country | US
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Telephone | 503-747-0120
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SEJUNG SHIN
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Credential | M.D.
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Telephone | 503-747-0120
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | MD22180
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License Number State | OR
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