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NPI Code Detail

MEDICARE: MITH LENG M.D.

MEDICARE: MITH LENG M.D.
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
1207Q00000XFamily Medicine PhysicianMD27317OR

General Provider Information

NPI Number : 1457306458
Entity Type Code : Individual
Provider Name (Legal Business Name) : MITH LENG M.D.
Provider Business Mailing Address
First Line : 9800 SE SUNNYSIDE RD
Second Line :
City : CLACKAMAS
State : OR
Zip : 97015-9750
Country : US
Telephone Number : 503-813-0378
Fax Number :
Provider Business Practice Location Address
First Line : 9800 SE SUNNYSIDE RD
Second Line :
City : CLACKAMAS
State : OR
Zip : 97015-9750
Country : US
Telephone Number : 503-813-0378
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2006
Last Update Date : 07/10/2007

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