Healthcare Provider Details

I. General information

NPI: 1992991269
Provider Name (Legal Business Name): PHU C DAO MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2007
Last Update Date: 09/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 SE WOODWARD ST
PORTLAND OR
97202-1552
US

IV. Provider business mailing address

3550 SE WOODWARD ST
PORTLAND OR
97202-1552
US

V. Phone/Fax

Practice location:
  • Phone: 503-517-8663
  • Fax: 503-943-4994
Mailing address:
  • Phone: 503-517-8663
  • Fax: 503-943-4994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: