MEDICARE: SOMCHANH VONGSOURY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist	H4529	OR

General Provider Information

NPI Number	:	1184587073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOMCHANH VONGSOURY

Provider Business Mailing Address
First Line	:	10626 SE 75TH AVE
Second Line	:
City	:	MILWAUKIE
State	:	OR
Zip	:	97222-2098
Country	:	US
Telephone Number	:	503-822-0117
Fax Number	:

Provider Business Practice Location Address
First Line	:	10626 SE 75TH AVE
Second Line	:
City	:	MILWAUKIE
State	:	OR
Zip	:	97222-2098
Country	:	US
Telephone Number	:	503-822-0117
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

Similar Medicare Providers

1770447336 — HEALING HOUSE PDX
Practice Location Address:

11827 SE 28TH AVE
MILWAUKIE, OR
97222-7722

Practice Phone: 503-915-6954
Practice Fax:

1255481115 — COUNTY OF CLACKAMAS
Practice Location Address:

12400 SE FREEMAN WAY
MILWAUKIE, OR
97222-4611

Practice Phone: 503-353-6127
Practice Fax: 503-353-6124

1487518817 — ANNE-MARIE LAGASSE
Practice Location Address:

2301 SE WILLARD ST
MILWAUKIE, OR
97222-7764

Practice Phone: 503-353-5830
Practice Fax:

1912861303 — JENNY FEDESCO
Practice Location Address:

3606 SE LAKE RD
MILWAUKIE, OR
97222-6949

Practice Phone: 503-353-5727
Practice Fax:

1811851207 — CHRISTINA TURNER
Practice Location Address:

7400 SE THOMPSON RD
MILWAUKIE, OR
97222-1967

Practice Phone: 503-353-5661
Practice Fax:

1982568374 — CRYSTAL GRABER
Practice Location Address:

8950 SE 36TH AVE
MILWAUKIE, OR
97222-5678

Practice Phone: 503-353-5320
Practice Fax:

Directions to “ SOMCHANH VONGSOURY ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.