Most Relevant Information
Provider Data
| NPI Number: | 1003266891 |
| Provider Name: | DEREK SUN |
| Entity Type: | Individual |
| Taxonomy Code: | 372600000X |
| Specialty: | Adult Companion |
| License Number: |
Most Important Dates
| Enumeration Date: | 06/13/2016 |
| Last Updated: | 06/13/2016 |
Provider Practice Location
847 NE 19TH AVE
SUITE 100
PORTLAND
OR
972322684
Practice Location Phone/Fax
| Phone: | 5032380769 |
| Fax: |
Provider Mailing Location
PO BOX 8459
PORTLAND
OR
972078459
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |