Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | H5232 | OR |
NPI | 1053742825 |
---|---|
Provider Name | Chau Nguyen |
First Address | Portland, OR 97211-3403 |
Second Address | Portland, OR 97239-2964 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2013 |
Last Update Date | 08/09/2014 |