Healthcare Provider Details

I. General information

NPI: 1225293285
Provider Name (Legal Business Name): EMILY C NGUYEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2008
Last Update Date: 08/25/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17355 LOWER BOONES FERRY RD STE 100A
PORTLAND OR
97035
US

IV. Provider business mailing address

17355 LOWER BOONES FERRY RD STE 100A
PORTLAND OR
97035
US

V. Phone/Fax

Practice location:
  • Phone: 503-224-8399
  • Fax: 503-224-5661
Mailing address:
  • Phone: 503-224-8399
  • Fax: 503-224-8399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number51880
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberMD176313
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: