Healthcare Provider Details

I. General information

NPI: 1861057291
Provider Name (Legal Business Name): THINA T NGUYEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2019
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10151 SE SUNNYSIDE RD STE 240
CLACKAMAS OR
97015-5774
US

IV. Provider business mailing address

10151 SE SUNNYSIDE RD STE 240
CLACKAMAS OR
97015-5774
US

V. Phone/Fax

Practice location:
  • Phone: 503-233-5548
  • Fax: 866-663-1070
Mailing address:
  • Phone: 503-233-5548
  • Fax: 866-663-1070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA201683
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: