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Individual

IVAN A WANG

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
5100 SW MACADAM AVE STE 200, PORTLAND, OR 97239-3827
(971) 202-5500
(971) 202-5555
Mailing address
2935 SW CEDAR HILLS BLVD, BEAVERTON, OR 97005-1342
(503) 352-6092
(503) 352-6080

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA155662
OR
363AM0700X
Medical Physician Assistant

Other

Enumeration date
11/15/2011
Last updated
02/08/2018
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