Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | DF0032 | OR |
Y | 213EG0000X | General Practice | DF0032 | OR |
N | 204E00000X | Oral & Maxillofacial Surgeon | DL10607 | MA |
NPI | 1265662894 |
---|---|
Provider Name | Ying Wu |
First Address | Portland, OR 97201 |
Second Address | Portland, OR 97239 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2009 |
Last Update Date | 19/08/2015 |