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Individual

THAO VAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
12345 SW HORIZON BLVD STE 57, BEAVERTON, OR 97007-9475
(503) 216-8820
Mailing address
12345 SW HORIZON BLVD STE 57, BEAVERTON, OR 97007-9475

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA169942
OR
363A00000X
Physician Assistant
PA60719666
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
500677387
OR
Enumeration date
08/13/2014
Last updated
10/13/2021
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