Healthcare Provider Details

I. General information

NPI: 1912300138
Provider Name (Legal Business Name): HUY TIEN HOANG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2014
Last Update Date: 10/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9800 SE WASHINGTON ST
PORTLAND OR
97216-2420
US

IV. Provider business mailing address

8612 NE CLACKAMAS ST
PORTLAND OR
97220-5639
US

V. Phone/Fax

Practice location:
  • Phone: 503-252-5850
  • Fax:
Mailing address:
  • Phone: 503-757-6258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPI-0010983
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberIR 60148871
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: