Provider Demographics
NPI:1013391895
Name:MENG, XIAO YANG (RDH)
Entity Type:Individual
Prefix:
First Name:XIAO
Middle Name:YANG
Last Name:MENG
Suffix:
Gender:M
Credentials:RDH
Other - Prefix:
Other - First Name:SONNY
Other - Middle Name:
Other - Last Name:MENG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDH
Mailing Address - Street 1:16611 SE MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97233-4046
Mailing Address - Country:US
Mailing Address - Phone:971-254-5655
Mailing Address - Fax:
Practice Address - Street 1:16611 SE MAIN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-4046
Practice Address - Country:US
Practice Address - Phone:971-254-5655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-12
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH6981124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist