Fan, Jessie

Fan, Jessie is an individual health care provider with primary practice located at 120 Nw 14Th Ave Suite 300, Portland OR 97209-2643. She recently has only one registered license in Allopathic & Osteopathic Physicians / Anesthesiology, which is considered as her primary health care specialty. Fan, Jessie can be contacted via phone (503) 299-9906.

Contact Information

Primary practice address
120 Nw 14Th Ave Suite 300 Portland OR 97209-2643
Phone: (503) 299-9906
Fax: (503) 225-9002
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Anesthesiology 207L00000X 227596 New York
Allopathic & Osteopathic Physicians / Anesthesiology 207L00000X MD27402 Oregon

Profile Details

NPI number 1932179439
LBN Legal business name Fan, Jessie
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 25th, 2006
Last updated Feb 15th, 2012 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1932179439 NPPES
Oregon MEDICAID 274300
Oregon MEDICAID 8482242

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