Individual
NIK THANASOUK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
13636 SE CALLAHAN RD, HAPPY VALLEY, OR 97086-6022
(503) 317-1531
Mailing address
13636 SE CALLAHAN RD, HAPPY VALLEY, OR 97086-6022
(503) 317-1531
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
09/22/2021
Last updated
09/22/2021
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