Active NPI
Gordon Jin Wong, R.PH.
- Pharmacist
- Portland, OR
National Provider Identifier
1568515781
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 36389
- Practice address
- 3710 SW US Veterans Hospital Road
Portland, OR 97239 - Phone
- (503) 220-8262
- NPI assigned
- Jan 19, 2007
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 36389 | TX | Primary |
Addresses
Primary practice location
3710 SW US Veterans Hospital Road
Portland, OR 97239
Mailing address
4075 SW 107TH Ave Apt 13
Beaverton, OR 97005-3255
Phone (503) 646-5576
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36389 | TX | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169164800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1568515781",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4075 SW 107TH AVE APT 13",
"city": "BEAVERTON",
"state": "OR",
"postal_code": "970053255",
"telephone_number": "503-646-5576"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3710 SW US VETERANS HOSPITAL ROAD",
"city": "PORTLAND",
"state": "OR",
"postal_code": "97239",
"telephone_number": "503-220-8262"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WONG",
"first_name": "GORDON",
"middle_name": "JIN",
"name_prefix": "Mr.",
"credential": "R.PH.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-19",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "36389",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.