Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | MD60556212 | WA |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | MD60556212 | WA |
NPI | 1104146620 |
---|---|
Provider Name | Yan Geng |
First Address | Portland, OR 97208-3360 |
Second Address | Lacey, WA 98503-6908 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2010 |
Last Update Date | 19/05/2021 |