Individual
JERRY WANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OP
Contact information
Practice address
3550 N INTERSTATE AVE, PORTLAND, OR 97227-1196
(321) 576-8536
Mailing address
3550 N INTERSTATE AVE, PORTLAND, OR 97227-1196
(321) 576-8536
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
OP61170696
WA
390200000X
Student in an Organized Health Care Education/Training Program
OP61170696
WA
Other
Enumeration date
06/03/2021
Last updated
09/24/2024
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