Provider Demographics
NPI:1659606747
Name:MAH, MANDY MIE YU
Entity Type:Individual
Prefix:
First Name:MANDY
Middle Name:MIE YU
Last Name:MAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3045 19TH AVE APT 23
Mailing Address - Street 2:
Mailing Address - City:FOREST GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97116-2648
Mailing Address - Country:US
Mailing Address - Phone:503-547-5160
Mailing Address - Fax:
Practice Address - Street 1:3045 19TH AVE APT 23
Practice Address - Street 2:
Practice Address - City:FOREST GROVE
Practice Address - State:OR
Practice Address - Zip Code:97116-2648
Practice Address - Country:US
Practice Address - Phone:503-547-5160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-07
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program