Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
JORDAN MYUNGDO WALLE
Active Sole ProprietorDental Public Health · KLAMATH FALLS, OR
Registration Details
- NPI Number
- 1780330282
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Feb 23, 2022 (4.1580755456239 yrs)
- Last Updated
- Jul 30, 2024
- License
-
D11718 (OR)
- Sole Proprietor
- Yes
Practice Information
- Address
-
2074 S 6TH STKLAMATH FALLS, OR, 976013372Browse OR providers · Browse ZIP 97601
- Phone
- 5418518110
- Primary Specialty
-
Dental Public Health
1223D0001X
- Additional Specialty
- Dental Public Health
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.