Healthcare Provider Details

I. General information

NPI: 1972584449
Provider Name (Legal Business Name): KAREN L FONG DC, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10360 NE WASCO ST
PORTLAND OR
97220-3927
US

IV. Provider business mailing address

5919 N BURRAGE AVE
PORTLAND OR
97217-4137
US

V. Phone/Fax

Practice location:
  • Phone: 503-252-8125
  • Fax:
Mailing address:
  • Phone: 503-254-5109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number272702
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC00220
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: