Healthcare Provider Details

I. General information

NPI: 1629639596
Provider Name (Legal Business Name): WAKABA CLAIRE OMI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2019
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7305 SE CIRCUIT DR STE 270
HILLSBORO OR
97129-1966
US

IV. Provider business mailing address

7305 SE CIRCUIT DR STE 270
HILLSBORO OR
97129-1966
US

V. Phone/Fax

Practice location:
  • Phone: 503-342-9931
  • Fax: 503-207-9463
Mailing address:
  • Phone: 503-342-9931
  • Fax: 503-207-9463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD228520
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: