Provider Demographics
NPI:1982888376
Name:NJENGA, JOHN (PA, MS, MHS, MPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:NJENGA
Suffix:
Gender:M
Credentials:PA, MS, MHS, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12710 SE DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97236-3134
Mailing Address - Country:US
Mailing Address - Phone:503-988-5578
Mailing Address - Fax:
Practice Address - Street 1:12710 SE DIVISION ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97236-3134
Practice Address - Country:US
Practice Address - Phone:503-988-5578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-21
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OROR01379207Q00000X
PAMA053309207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
OROR01379OtherOREGON MEDICAL BOARD
MDC03762OtherMARYLAND MEDICAL BOARD
ORPA601442006OtherWASHINGTON BOARD OF MEDICINE
PAMA053309OtherPENNSYLVANIA MEDICAL BOARD