MEDICARE: SUJEN KAYLEE KUNUGIYAMA CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	200541558RN	OR
2	367500000X	Certified Registered Nurse Anesthetist	201503389CRNA-PP	OR
3	163W00000X	Registered Nurse	NUR-RN-LIC-91351	MT
4	163W00000X	Registered Nurse	RN60306187	WA

General Provider Information

NPI Number	:	1477948628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUJEN KAYLEE KUNUGIYAMA CRNA

Provider Business Mailing Address
First Line	:	500 NE MULTNOMAH ST
Second Line	:	SUITE 100
City	:	PORTLAND
State	:	OR
Zip	:	97232-2023
Country	:	US
Telephone Number	:	503-813-3860
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 NE MULTNOMAH ST
Second Line	:	SUITE 100
City	:	PORTLAND
State	:	OR
Zip	:	97232-2023
Country	:	US
Telephone Number	:	503-813-3860
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2015
Last Update Date	:	12/17/2025

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