Provider Demographics
NPI: | 1922091099 |
---|---|
Name: | WANG, ANNE HSIAO-YUEN (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | ANNE |
Middle Name: | HSIAO-YUEN |
Last Name: | WANG |
Suffix: | |
Gender: | F |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 541 NE 20TH AVE STE 225 |
Mailing Address - Street 2: | |
Mailing Address - City: | PORTLAND |
Mailing Address - State: | OR |
Mailing Address - Zip Code: | 97232-2895 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 503-963-2801 |
Mailing Address - Fax: | 503-963-2825 |
Practice Address - Street 1: | 1111 NE 99TH AVE |
Practice Address - Street 2: | SUITE 301 |
Practice Address - City: | PORTLAND |
Practice Address - State: | OR |
Practice Address - Zip Code: | 97220-9428 |
Practice Address - Country: | US |
Practice Address - Phone: | 503-963-2707 |
Practice Address - Fax: | 503-963-2802 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2005-08-24 |
Last Update Date: | 2023-12-06 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
OR | MD20419 | 207RG0100X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207RG0100X | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
OR | 150015 | Medicaid | |
WA | 8206542 | Medicaid | |
OR | 100009755 | Medicare PIN | |
OR | 143452 | Medicare PIN | |
OR | E50377 | Medicare UPIN | |
OR | 109987 | Medicare ID - Type Unspecified |