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Individual

UY SY NGO

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
5611 SE 145TH AVE, PORTLAND, OR 97236-4005
(971) 344-6657
Mailing address
5611 SE 145TH AVE, PORTLAND, OR 97236-4005

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA216624
OR

Other

Enumeration date
07/10/2023
Last updated
07/10/2023
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