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NPI Code Detail

MEDICARE: DR. KIMBERLY LI CHING MICHIKO KISOR M.D.

MEDICARE: DR. KIMBERLY LI CHING MICHIKO KISOR M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine PhysicianOR MD21827OR

General Provider Information

NPI Number : 1649380734
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KIMBERLY LI CHING MICHIKO KISOR M.D.
Provider Business Mailing Address
First Line : 500 NE MULTNOMAH ST STE 100
Second Line :
City : PORTLAND
State : OR
Zip : 97232-2099
Country : US
Telephone Number : 800-813-2000
Fax Number :
Provider Business Practice Location Address
First Line : 19185 SW 90TH AVE
Second Line :
City : TUALATIN
State : OR
Zip : 97062-7558
Country : US
Telephone Number : 800-813-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2006
Last Update Date : 04/07/2026

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