Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | D10262 | OR |
NPI | 1003298605 |
---|---|
Provider Name | Ngan Hoang |
First Address | Beaverton, OR 97007-6983 |
Second Address | Gresham, OR 97030-7255 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2015 |
Last Update Date | 19/06/2015 |