Healthcare Provider Details

I. General information

NPI: 1902040777
Provider Name (Legal Business Name): RAJAN P KULKARNI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2009
Last Update Date: 07/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3303 SW BOND AVE STE 16
PORTLAND OR
97239
US

IV. Provider business mailing address

3303 SW BOND AVE STE 16
PORTLAND OR
97239-4501
US

V. Phone/Fax

Practice location:
  • Phone: 503-418-3376
  • Fax: 503-494-6968
Mailing address:
  • Phone: 503-418-3376
  • Fax: 503-494-6968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA113764
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD186821
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: