Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223D0001X | Dental Public Health | D7539 | OR |
Y | 1223G0001X | General Practice | 7539 | OR |
Y | 213EG0000X | General Practice | 7539 | OR |
NPI | 1477616720 |
---|---|
Provider Name | Jia Lin Goh |
First Address | Portland, OR 97238-6255 |
Second Address | Portland, OR 97222-7646 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2006 |
Last Update Date | 15/03/2012 |