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General NPI Number Information
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NPI Number | 1306859707
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Entity Type | Organization
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Legal Business Name | WESTSIDE CARDIOLOGY PC
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Dates
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Enumeration Date | 08/15/2006
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Last Update Date | 07/30/2007
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Provider Practice Location Address
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Address Line | 730 SE OAK ST STE I
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City | HILLSBORO
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State | OR
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Zip | 97123-4245
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Country | US
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Telephone | 503-846-0406
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Fax | 503-846-0408
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Provider Business Mailing Address
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Address Line | PO BOX 533
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City | HILLSBORO
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State | OR
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Zip | 97123-0533
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Country | US
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Telephone | 503-846-0406
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Fax | 503-846-0408
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHARLES C. OH
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Credential | MD
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Telephone | 503-846-0406
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | MD20834
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License Number State | OR
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