Healthcare Provider Details

I. General information

NPI: 1851557607
Provider Name (Legal Business Name): LAKE OSWEGO FOOT CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2008
Last Update Date: 09/09/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 MEADOWS RD. STE 120
LAKE OSWEGO OR
97035
US

IV. Provider business mailing address

4800 MEADOWS RD. STE 120
LAKE OSWEGO OR
97035
US

V. Phone/Fax

Practice location:
  • Phone: 503-636-9656
  • Fax: 503-636-9657
Mailing address:
  • Phone: 503-636-9656
  • Fax: 503-636-9657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License NumberDP00338
License Number StateOR

VIII. Authorized Official

Name: DR. JERRY J YOON
Title or Position: PHYSICIAN/OWNER
Credential: DPM
Phone: 503-636-9656