Healthcare Provider Details

I. General information

NPI: 1063308955
Provider Name (Legal Business Name): LITTLE ISLAND PEDIATRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2025
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17200 NW CORRIDOR CT STE 112
BEAVERTON OR
97006-3295
US

IV. Provider business mailing address

17200 NW CORRIDOR CT STE 112
BEAVERTON OR
97006-3295
US

V. Phone/Fax

Practice location:
  • Phone: 503-966-3757
  • Fax: 503-212-0432
Mailing address:
  • Phone: 503-966-3757
  • Fax: 503-212-0432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: LING-AN WU
Title or Position: OWNER
Credential: MD
Phone: 503-966-3757