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General NPI Number Information
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NPI Number | 1952474009
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Entity Type | Individual
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Provider Name | HENRY S JUAN MD
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Gender | Male
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 08/01/2025
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Provider Practice Location Address
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Address Line | 12607 SE MILL PLAIN BLVD
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City | VANCOUVER
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State | WA
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Zip | 98684-6055
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Country | US
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Telephone | 800-813-2000
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Fax | 360-896-4470
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Provider Business Mailing Address
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Address Line | 12607 SE MILL PLAIN BLVD
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City | VANCOUVER
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State | WA
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Zip | 98684-6055
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Country | US
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Telephone | 800-813-2000
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Fax | 360-896-4470
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 190609
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | IMLC.MD.60902208
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 125-030506
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 38324
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License Number State | WI
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