Healthcare Provider Details

I. General information

NPI: 1912346461
Provider Name (Legal Business Name): VISHAL KHEMLANI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2013
Last Update Date: 05/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6464 SW BORLAND RD STE A2
TUALATIN OR
97062-8854
US

IV. Provider business mailing address

6464 SW BORLAND RD STE A2
TUALATIN OR
97062-8854
US

V. Phone/Fax

Practice location:
  • Phone: 503-885-1515
  • Fax: 503-885-1520
Mailing address:
  • Phone: 503-885-1515
  • Fax: 503-885-1520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberMD186805
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD186805
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: