Healthcare Provider Details

I. General information

NPI: 1851558563
Provider Name (Legal Business Name): KIRIN N PALMER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 11/02/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15405 SW 116TH AVE STE 116
KING CITY OR
97224-2600
US

IV. Provider business mailing address

355 NW ORCHARD DR
PORTLAND OR
97229-6256
US

V. Phone/Fax

Practice location:
  • Phone: 503-420-8667
  • Fax: 971-512-3246
Mailing address:
  • Phone: 503-420-8667
  • Fax: 971-512-3246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD167618
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierMD21148
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerSTATE LICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: