Provider Demographics
NPI:1578135075
Name:WANG, YUXUAN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:YUXUAN
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:JERRY
Other - Middle Name:
Other - Last Name:WANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:7800 SW DURHAM RD STE 500
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7578
Mailing Address - Country:US
Mailing Address - Phone:323-847-7987
Mailing Address - Fax:
Practice Address - Street 1:7800 SW DURHAM RD STE 500
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-7578
Practice Address - Country:US
Practice Address - Phone:323-847-7987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP20455225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist