Doctor Name: | CHUNG SO |
NPI Number: | 1003172412 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LMT(OREGON #4132) |
License Number: | LMT#4132 |
Business Practice Address: | 1616 Se Bybee Blvd Portland, OR - 972025715 |
Business Phone Number: | 5032364654 |
Business Fax Number: | |
Mailing Address: | 6311 Nw Firwood Drive, VANCOUVER |
State: | WA |
Postal Code: | 986658511 |
Phone Number: | 3607984255 |
Fax Number: | |
NPI Enumeration Date: | 04/10/2012 |
NPI Last Update Date: | 04/10/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | LMT#4132 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OR |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Massage Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |