Individual
CHUNG SO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT(OREGON #4132)
Contact information
Practice address
1616 SE BYBEE BLVD, PORTLAND, OR 97202-5715
(503) 236-4654
Mailing address
6311 NW FIRWOOD DRIVE, VANCOUVER, WA 98665-8511
(360) 798-4255
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
LMT#4132
OR
Other
Enumeration date
04/10/2012
Last updated
04/10/2012
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