Healthcare Provider Details

I. General information

NPI: 1780855502
Provider Name (Legal Business Name): VIYADA THONGOUTHAITHIP MD & CARMELINDO SIQUEIRA JR MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2008
Last Update Date: 05/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9155 SW BARNES RD STE 310
PORTLAND OR
97225-6630
US

IV. Provider business mailing address

9155 SW BARNES RD STE 310
PORTLAND OR
97225-6630
US

V. Phone/Fax

Practice location:
  • Phone: 503-297-8491
  • Fax: 503-297-8492
Mailing address:
  • Phone: 503-297-8491
  • Fax: 503-297-8492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD 12967
License Number StateOR

VIII. Authorized Official

Name: DR. VIYADA THONGOUTHAITHIP, M.D.
Title or Position: CARDIOLOGIST
Credential: M.D.
Phone: 503-297-8491