Healthcare Provider Details

I. General information

NPI: 1508166505
Provider Name (Legal Business Name): JASON KUAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2010
Last Update Date: 02/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13485 NW CORNELL RD
PORTLAND OR
97229-5819
US

IV. Provider business mailing address

12887 NW LORRAINE DR
PORTLAND OR
97229-8371
US

V. Phone/Fax

Practice location:
  • Phone: 503-350-2086
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12142
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH-0012142
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: