Provider Demographics
NPI:1164487609
Name:NOIMANY, VIENGKEO T (DPM)
Entity Type:Individual
Prefix:DR
First Name:VIENGKEO
Middle Name:T
Last Name:NOIMANY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18231 SIENA DR
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-3263
Mailing Address - Country:US
Mailing Address - Phone:503-702-3803
Mailing Address - Fax:
Practice Address - Street 1:18231 SIENA DR
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-3263
Practice Address - Country:US
Practice Address - Phone:503-702-3803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC005897213ES0103X
ORDP153670213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery