Provider Demographics
NPI:1316453087
Name:PHAN, AN HOANG
Entity type:Individual
Prefix:
First Name:AN
Middle Name:HOANG
Last Name:PHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2850 SE 82ND AVE UNIT 8
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-1599
Mailing Address - Country:US
Mailing Address - Phone:503-777-3000
Mailing Address - Fax:
Practice Address - Street 1:2850 SE 82ND AVE UNIT 8
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-1599
Practice Address - Country:US
Practice Address - Phone:503-777-3000
Practice Address - Fax:503-777-0002
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-18
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1395175F00000X
ORAC00902171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
No175F00000XOther Service ProvidersNaturopathGroup - Single Specialty