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General NPI Number Information
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NPI Number | 1942978382
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Entity Type | Individual
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Provider Name | KYUNG SUNWOO DMD
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Gender | Female
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Dates
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Enumeration Date | 08/31/2021
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Last Update Date | 08/31/2021
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Provider Practice Location Address
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Address Line | 310 SW 4TH AVE STE 100
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City | PORTLAND
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State | OR
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Zip | 97204-2345
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Country | US
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Telephone | 503-489-4530
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Fax |
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Provider Business Mailing Address
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Address Line | 21001 NW OLD PASS RD
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City | HILLSBORO
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State | OR
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Zip | 97124-8559
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Country | US
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Telephone | 323-684-7889
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | D11521
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License Number State | OR
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