Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | H5768 | OR |
NPI | 1073144671 |
---|---|
Provider Name | Michelle Yen Nguyen |
First Address | Happy Valley, OR 97086-4459 |
Second Address | Happy Valley, OR 97086-4468 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2020 |
Last Update Date | 22/12/2021 |