Basic Information
| Provider Information | |||||||||
| NPI: | 1376863340 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NGOCTHUY HUGHES DO PC | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1245 NW 4TH ST | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | REDMOND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977561680 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5415487761 | ||||||||
| FaxNumber: | 5415266554 | ||||||||
| Practice Location | |||||||||
| Address1: | 1245 NW 4TH ST | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | REDMOND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977561680 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5415487761 | ||||||||
| FaxNumber: | 5415266554 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2010 | ||||||||
| LastUpdateDate: | 06/01/2010 | ||||||||
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| AuthorizedOfficialLastName: | HUGHES | ||||||||
| AuthorizedOfficialFirstName: | NGOCTHUY | ||||||||
| AuthorizedOfficialMiddleName: | T | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 5415487761 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | DO | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | DO27545 | OR | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 241531 | 05 | OR | MEDICAID |