Provider Demographics
NPI:1104631175
Name:FUN, SARA
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:FUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1845 PORTLAND ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-2260
Mailing Address - Country:US
Mailing Address - Phone:503-502-6441
Mailing Address - Fax:
Practice Address - Street 1:200 UNIVERSITY PKWY
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98901-9539
Practice Address - Country:US
Practice Address - Phone:509-452-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-07
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program