Individual
PHONG LY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3303 S BOND AVE, PORTLAND, OR 97239-4501
(503) 494-7246
Mailing address
3181 SW SAM JACKSON PARK RD, MAIL CODE SJH-2, PORTLAND, OR 97239
(503) 494-7246
(503) 494-8368
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
Primary
PA218098
OR
Other
Enumeration date
08/16/2023
Last updated
12/19/2023
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