Provider Demographics
NPI:1073295234
Name:NGAN, TSANG TSANG SAM
Entity Type:Individual
Prefix:
First Name:TSANG TSANG SAM
Middle Name:
Last Name:NGAN
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 1:11933 NE GLENN WIDING DR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-9099
Mailing Address - Country:US
Mailing Address - Phone:503-819-6030
Mailing Address - Fax:
Practice Address - Street 1:11933 NE GLENN WIDING DR
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-9099
Practice Address - Country:US
Practice Address - Phone:503-819-6030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR486911835G0303X
TX721141835G0303X
OR94761835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric