Provider Demographics
NPI:1316440324
Name:HA, EUNKYOUNG (LMT)
Entity type:Individual
Prefix:
First Name:EUNKYOUNG
Middle Name:
Last Name:HA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 975
Mailing Address - Street 2:
Mailing Address - City:ESTACADA
Mailing Address - State:OR
Mailing Address - Zip Code:97023-0975
Mailing Address - Country:US
Mailing Address - Phone:321-750-8984
Mailing Address - Fax:
Practice Address - Street 1:8695 SW JACK BURNS BLVD STE E
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-5797
Practice Address - Country:US
Practice Address - Phone:503-427-2698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-15
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR023334225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist