Provider Demographics
NPI:1417223629
Name:HUANG, MEGAN (PA)
Entity Type:Individual
Prefix:MISS
First Name:MEGAN
Middle Name:
Last Name:HUANG
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:JEFFORDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:10803 SE CHERRY BLOSSOM DR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-3107
Mailing Address - Country:US
Mailing Address - Phone:503-261-7200
Mailing Address - Fax:
Practice Address - Street 1:10803 SE CHERRY BLOSSOM DR
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-3107
Practice Address - Country:US
Practice Address - Phone:503-261-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-02
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1020398133V00000X
ORPA180927363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GALD003593OtherGEORGIA BOARD OF EXAMINERS OF LICENSED DIETITIANS
GA01020398OtherCOMMISSION ON DIETETIC REGISTRATION
OR500719911Medicaid