Provider Demographics
NPI:1396397261
Name:NGUYEN, KHANH-UYEN TINA HUU (PA)
Entity Type:Individual
Prefix:
First Name:KHANH-UYEN TINA
Middle Name:HUU
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:FOREST GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97116-1939
Mailing Address - Country:US
Mailing Address - Phone:503-359-6180
Mailing Address - Fax:503-359-6105
Practice Address - Street 1:1825 MAPLE ST
Practice Address - Street 2:
Practice Address - City:FOREST GROVE
Practice Address - State:OR
Practice Address - Zip Code:97116-1939
Practice Address - Country:US
Practice Address - Phone:503-359-6180
Practice Address - Fax:503-359-6105
Is Sole Proprietor?:No
Enumeration Date:2019-07-11
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60963344207Q00000X
ORPA189616363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine