Healthcare Provider Details

I. General information

NPI: 1407958358
Provider Name (Legal Business Name): KARI HANCOCK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KARI KAWAKAMI M.D.

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 06/16/2022
Certification Date: 06/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14523 WESTLAKE DR STE 4
LAKE OSWEGO OR
97035-7700
US

IV. Provider business mailing address

14523 WESTLAKE DR STE 4
LAKE OSWEGO OR
97035-7700
US

V. Phone/Fax

Practice location:
  • Phone: 503-744-4952
  • Fax: 503-664-4098
Mailing address:
  • Phone: 503-744-4952
  • Fax: 503-664-4098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD164102
License Number StateOR

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: