Healthcare Provider Details

I. General information

NPI: 1861756470
Provider Name (Legal Business Name): FERNANDA V HUANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2012
Last Update Date: 02/08/2023
Certification Date: 02/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16463 BOONES FERRY RD STE 100
LAKE OSWEGO OR
97035-4374
US

IV. Provider business mailing address

16463 BOONES FERRY RD STE 100
LAKE OSWEGO OR
97035-4374
US

V. Phone/Fax

Practice location:
  • Phone: 503-635-1350
  • Fax: 503-635-8470
Mailing address:
  • Phone: 503-635-1350
  • Fax: 503-635-8470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0116025151
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD174932
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: