Provider Demographics
NPI:1659598944
Name:HU, CHARLES Y (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:Y
Last Name:HU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:1650 NW NAITO PKWY
Mailing Address - Street 2:STE 185
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-2535
Mailing Address - Country:US
Mailing Address - Phone:503-525-5600
Mailing Address - Fax:971-983-5326
Practice Address - Street 1:2801 N GANTENBEIN AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1623
Practice Address - Country:US
Practice Address - Phone:503-413-8407
Practice Address - Fax:503-413-6951
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD24528207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR297642Medicaid
ORI01368Medicare UPIN
OR297642Medicaid