Healthcare Provider Details

I. General information

NPI: 1558364489
Provider Name (Legal Business Name): CAROLINE MAY-SAN FUNG P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 02/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9555 SW BARNES RD STE 150
PORTLAND OR
97225-6663
US

IV. Provider business mailing address

9555 SW BARNES RD STE 150
PORTLAND OR
97225-6663
US

V. Phone/Fax

Practice location:
  • Phone: 503-297-7403
  • Fax: 503-384-9908
Mailing address:
  • Phone: 503-297-7403
  • Fax: 503-384-9908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA00763
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: