Provider Demographics
NPI:1669851721
Name:OBENG, ISAAC (PA)
Entity Type:Individual
Prefix:
First Name:ISAAC
Middle Name:
Last Name:OBENG
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4755 SE LLEWELLYN ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-1602
Mailing Address - Country:US
Mailing Address - Phone:503-841-3798
Mailing Address - Fax:
Practice Address - Street 1:5050 NE HOYT ST STE 626
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2956
Practice Address - Country:US
Practice Address - Phone:503-231-1426
Practice Address - Fax:503-234-7015
Is Sole Proprietor?:No
Enumeration Date:2015-05-22
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAPPLIED363AS0400X
ORPA179379207XS0114X
OR390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program