Basic Information
| Provider Information | |||||||||
| NPI: | 1891049128 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TRIEU | ||||||||
| FirstName: | JESSIE | ||||||||
| MiddleName: | KHA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6689 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972286689 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034133900 | ||||||||
| FaxNumber: | 5034133710 | ||||||||
| Practice Location | |||||||||
| Address1: | 2020 8TH AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | WEST LINN | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036553320 | ||||||||
| FaxNumber: | 5036553321 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2012 | ||||||||
| LastUpdateDate: | 04/10/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A123561 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MD190504 | OR | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.