Provider Demographics
NPI:1134471873
Name:NGUYEN, QUANG MICHAEL-DANG
Entity Type:Individual
Prefix:
First Name:QUANG
Middle Name:MICHAEL-DANG
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8915 SW CENTER ST.
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223
Mailing Address - Country:US
Mailing Address - Phone:503-726-3740
Mailing Address - Fax:503-726-3741
Practice Address - Street 1:9035 SE FOSTER RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-4617
Practice Address - Country:US
Practice Address - Phone:503-872-8822
Practice Address - Fax:503-872-8825
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-04
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health