Provider Demographics
NPI:1356469902
Name:HUANG, TED (MD)
Entity type:Individual
Prefix:DR
First Name:TED
Middle Name:
Last Name:HUANG
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 1:24988 SE STARK ST
Mailing Address - Street 2:SUITE 140
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-8322
Mailing Address - Country:US
Mailing Address - Phone:503-661-1112
Mailing Address - Fax:503-661-1422
Practice Address - Street 1:24988 SE STARK ST
Practice Address - Street 2:SUITE 140
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-8322
Practice Address - Country:US
Practice Address - Phone:503-661-1112
Practice Address - Fax:503-661-1422
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD431768207R00000X
ORMD154931207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine