Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MD191780 | OR |
N | 111NI0900X | Internist | MD191780 | OR |
Y | 207RA0401X | Internist - Addiction Medicine | MD191780 | OR |
NPI | 1164953725 |
---|---|
Provider Name | Linda Peng |
First Address | Portland, OR 97239-3011 |
Second Address | Portland, OR 97239-3011 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2017 |
Last Update Date | 02/09/2021 |