Healthcare Provider Details

I. General information

NPI: 1710120845
Provider Name (Legal Business Name): JENNY LARA SEMADENI MALCOM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2009
Last Update Date: 01/30/2026
Certification Date: 01/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7213 SW HAZEL FERN RD STE 200
PORTLAND OR
97224-7716
US

IV. Provider business mailing address

7213 SW HAZEL FERN RD
TIGARD OR
97224-7716
US

V. Phone/Fax

Practice location:
  • Phone: 503-214-2064
  • Fax: 503-598-3600
Mailing address:
  • Phone: 503-667-8878
  • Fax: 503-598-3600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD157635
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: