Healthcare Provider Details

I. General information

NPI: 1508556549
Provider Name (Legal Business Name): MS. XIAOFEN HUANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2023
Last Update Date: 05/12/2023
Certification Date: 05/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 B AVE STE W
LAKE OSWEGO OR
97034-3071
US

IV. Provider business mailing address

SE OAK STREET 12093
PORTLAND OR
97216
US

V. Phone/Fax

Practice location:
  • Phone: 971-421-9043
  • Fax:
Mailing address:
  • Phone: 971-421-9043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number61404091
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number26704
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: