Provider Demographics
NPI:1013979533
Name:NGUYEN, HOANG Q (MD)
Entity Type:Individual
Prefix:DR
First Name:HOANG
Middle Name:Q
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3202 SE 82ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-2004
Mailing Address - Country:US
Mailing Address - Phone:503-777-5995
Mailing Address - Fax:503-777-8005
Practice Address - Street 1:3202 SE 82ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-2004
Practice Address - Country:US
Practice Address - Phone:503-777-5995
Practice Address - Fax:503-777-8005
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD25723207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0207265OtherWA LABOR & INDUSTRIES
WA8449670Medicaid
OR272028Medicaid
OR278172Medicaid
WAP00360355OtherRAILROAD MEDICARE
OR272028Medicaid
OR278172Medicaid
WA8449670Medicaid
WA8858790Medicare ID - Type UnspecifiedCASCADE LOCATION