Provider Demographics
NPI:1306692967
Name:SUNNY WANG MASSAGE LLC
Entity type:Organization
Organization Name:SUNNY WANG MASSAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOFGREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:971-217-8770
Mailing Address - Street 1:10706 NE 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-1066
Mailing Address - Country:US
Mailing Address - Phone:503-683-3353
Mailing Address - Fax:
Practice Address - Street 1:14455 SW ALLEN BLVD STE 101
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-4428
Practice Address - Country:US
Practice Address - Phone:503-683-3353
Practice Address - Fax:972-329-4668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-25
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty