Healthcare Provider Details

I. General information

NPI: 1124511191
Provider Name (Legal Business Name): ENK DENTAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2018
Last Update Date: 06/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6516 NE SISKIYOU ST
PORTLAND OR
97213-4572
US

IV. Provider business mailing address

6516 NE SISKIYOU ST
PORTLAND OR
97213-4572
US

V. Phone/Fax

Practice location:
  • Phone: 503-281-4142
  • Fax:
Mailing address:
  • Phone: 503-281-4142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberD8001
License Number StateOR

VIII. Authorized Official

Name: DR. ERIC N KIM
Title or Position: PRESIDENT
Credential: DDS
Phone: 503-830-9281