Individual
ANGE MONG LY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
24800 SE STARK ST, GRESHAM, OR 97030-3378
(503) 674-1122
Mailing address
24800 SE STARK ST, GRESHAM, OR 97030-3378
(503) 674-1122
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD160078
OR
Other
Enumeration date
06/13/2010
Last updated
07/05/2013
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