Provider Demographics
NPI: | 1942507447 |
---|---|
Name: | FANG, SOPHIA YING (MD, MS) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | SOPHIA |
Middle Name: | YING |
Last Name: | FANG |
Suffix: | |
Gender: | F |
Credentials: | MD, MS |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 14521 265TH PL NE |
Mailing Address - Street 2: | |
Mailing Address - City: | DUVALL |
Mailing Address - State: | WA |
Mailing Address - Zip Code: | 98019-8363 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 213-663-7484 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 9735 SW SHADY LN STE 203 |
Practice Address - Street 2: | |
Practice Address - City: | TIGARD |
Practice Address - State: | OR |
Practice Address - Zip Code: | 97223-5481 |
Practice Address - Country: | US |
Practice Address - Phone: | 503-635-4436 |
Practice Address - Fax: | 971-317-0283 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2011-02-17 |
Last Update Date: | 2020-07-14 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
OR | MD198768 | 207WX0110X |
UT | 10772872-1205 | 207W00000X |
390200000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207WX0110X | Allopathic & Osteopathic Physicians | Ophthalmology | Pediatric Ophthalmology and Strabismus Specialist |
No | 207W00000X | Allopathic & Osteopathic Physicians | Ophthalmology | |
No | 390200000X | Student, Health Care | Student in an Organized Health Care Education/Training Program |