Individual
SAM NGUYEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
12900 NE ROSE PKWY, PORTLAND, OR 97230-1550
(503) 841-1379
Mailing address
14828 NE ALTON ST, PORTLAND, OR 97230-4467
(503) 841-1379
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA174721
OR
Other
Enumeration date
09/19/2014
Last updated
01/15/2020
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