Healthcare Provider Details

I. General information

NPI: 1417956020
Provider Name (Legal Business Name): DAVID MING FUNG KAO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 03/30/2022
Certification Date: 03/30/2022
Deactivation Date: 03/18/2006
Reactivation Date: 03/23/2006

III. Provider practice location address

6370 SW BORLAND RD STE 200
TUALATIN OR
97062-9752
US

IV. Provider business mailing address

6370 SW BORLAND RD STE 200
TUALATIN OR
97062-9752
US

V. Phone/Fax

Practice location:
  • Phone: 503-691-1122
  • Fax: 503-691-1144
Mailing address:
  • Phone: 503-691-1122
  • Fax: 503-691-1144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number23409
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: