Individual
SOOHAN BONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5050 NE HOYT ST STE 359, PORTLAND, OR 97213-2983
(503) 935-8501
(503) 935-8506
Mailing address
847 NE 19TH AVE STE 300, PORTLAND, OR 97232-2686
(503) 963-2801
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA207120
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500813996
—
OR
Enumeration date
09/04/2020
Last updated
02/07/2023
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