Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | H6981 | OR |
NPI | 1013391895 |
---|---|
Provider Name | Xiao Yang Meng |
First Address | Portland, OR 97233-4046 |
Second Address | Portland, OR 97233-4046 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2015 |
Last Update Date | 16/07/2015 |