Individual
JONATHAN OUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
7162 E 19TH ST, TUCSON, AZ 85710-4909
(520) 891-5323
Mailing address
994 S HARRISON RD, TUCSON, AZ 85748-6608
(520) 721-1887
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
7545042
AZ
Other
Enumeration date
08/08/2016
Last updated
08/08/2016
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