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
StateLicense IDTaxonomies
ORMD198768207WX0110X
UT10772872-1205207W00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0110XAllopathic & Osteopathic PhysiciansOphthalmologyPediatric Ophthalmology and Strabismus Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program