Healthcare Provider Details

I. General information

NPI: 1356469902
Provider Name (Legal Business Name): TED HUANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 03/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24988 SE STARK ST SUITE 140
GRESHAM OR
97030-8322
US

IV. Provider business mailing address

24988 SE STARK ST SUITE 140
GRESHAM OR
97030-8322
US

V. Phone/Fax

Practice location:
  • Phone: 503-661-1112
  • Fax: 503-661-1422
Mailing address:
  • Phone: 503-661-1112
  • Fax: 503-661-1422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD431768
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD154931
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: