Healthcare Provider Details

I. General information

NPI: 1770650194
Provider Name (Legal Business Name): KIM CHI VU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 03/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15390 NW CORNELL RD SUITE 225
BEAVERTON OR
97006-5627
US

IV. Provider business mailing address

15390 NW CORNELL RD SUITE 225
BEAVERTON OR
97006-5627
US

V. Phone/Fax

Practice location:
  • Phone: 503-601-2910
  • Fax: 503-601-2914
Mailing address:
  • Phone: 503-601-2910
  • Fax: 503-601-2914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD24426
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: