Healthcare Provider Details

I. General information

NPI: 1417223629
Provider Name (Legal Business Name): MEGAN HUANG PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN JEFFORDS PA

II. Dates (important events)

Enumeration Date: 04/02/2012
Last Update Date: 06/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10803 SE CHERRY BLOSSOM DR
PORTLAND OR
97216-3107
US

IV. Provider business mailing address

10803 SE CHERRY BLOSSOM DR
PORTLAND OR
97216-3107
US

V. Phone/Fax

Practice location:
  • Phone: 503-261-7200
  • Fax:
Mailing address:
  • Phone: 503-261-7200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1020398
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA180927
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: