Healthcare Provider Details

I. General information

NPI: 1659539096
Provider Name (Legal Business Name): DEAN LI-JIN LAOCHAMROONVORAPONGSE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DEAN LAO M.D.

II. Dates (important events)

Enumeration Date: 05/31/2008
Last Update Date: 05/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 SW 4TH AVE 616
PORTLAND OR
97201-5512
US

IV. Provider business mailing address

1720 SW 4TH AVE 616
PORTLAND OR
97201-5512
US

V. Phone/Fax

Practice location:
  • Phone: 917-848-5581
  • Fax:
Mailing address:
  • Phone: 917-848-5581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number153816
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number153816
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: