Basic Information
| Provider Information | |||||||||
| NPI: | 1376982421 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WUNGJIRANIRUN | ||||||||
| FirstName: | MANIDA | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3303 S BOND AVE | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972394501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034944373 | ||||||||
| FaxNumber: | 5034184189 | ||||||||
| Practice Location | |||||||||
| Address1: | 3303 S BOND AVE | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972394501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034944373 | ||||||||
| FaxNumber: | 5034184189 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2013 | ||||||||
| LastUpdateDate: | 09/09/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD201355 | OR | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0100X | MD201355 | OR | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.