Healthcare Provider Details

I. General information

NPI: 1235534314
Provider Name (Legal Business Name): YUKO IWANAGA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2014
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 OAK ST SE
SALEM OR
97301-3905
US

IV. Provider business mailing address

800 MCCONNELL RD
COLUMBUS OH
43214-3463
US

V. Phone/Fax

Practice location:
  • Phone: 503-561-5200
  • Fax:
Mailing address:
  • Phone: 614-533-6297
  • Fax: 614-533-6226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number34.014076
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberDO202411
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: