Basic Information
| Provider Information | |||||||||
| NPI: | 1700396967 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MA | ||||||||
| FirstName: | JING | ||||||||
| MiddleName: | CHENG | ||||||||
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| Credential: | PHARM D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16410 SE HIGH MEADOW LOOP | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972369388 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5039984477 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11425 SW BEAVERTON HILLSDALE HWY | ||||||||
| Address2: | |||||||||
| City: | BEAVERTON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970053050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035261833 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2017 | ||||||||
| LastUpdateDate: | 10/05/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | RPH-0016284 | OR | N | Pharmacy Service Providers | Pharmacist | 1835P0018X | RPH-0016284 | OR | Y | Pharmacy Service Providers | Pharmacist | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
No ID Information.