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General NPI Number Information
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NPI Number | 1174057202
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Entity Type | Individual
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Provider Name | TANG KHANG VANG MLS
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Gender | Female
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Dates
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Enumeration Date | 04/15/2017
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Last Update Date | 04/15/2017
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Provider Practice Location Address
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Address Line | 3710 SW US VETERANS HOSPITAL RD
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City | PORTLAND
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State | OR
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Zip | 97239-2964
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Country | US
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Telephone | 503-220-8262
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Fax |
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Provider Business Mailing Address
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Address Line | 9900 SE 282ND AVE
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City | BORING
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State | OR
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Zip | 97009-8414
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Country | US
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Telephone | 503-709-2390
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246RM2200X
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Taxonomy Name | Medical Laboratory Technician
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License Number | 258616
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License Number State | OR
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