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General NPI Number Information
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NPI Number | 1780855502
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Entity Type | Organization
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Legal Business Name | VIYADA THONGOUTHAITHIP MD & CARMELINDO SIQUEIRA JR MD PC
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Dates
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Enumeration Date | 03/19/2008
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Last Update Date | 05/12/2014
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Provider Practice Location Address
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Address Line | 9155 SW BARNES RD STE 310
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City | PORTLAND
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State | OR
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Zip | 97225-6630
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Country | US
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Telephone | 503-297-8491
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Fax | 503-297-8492
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Provider Business Mailing Address
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Address Line | 9155 SW BARNES RD STE 310
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City | PORTLAND
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State | OR
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Zip | 97225-6630
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Country | US
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Telephone | 503-297-8491
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Fax | 503-297-8492
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Authorized Official
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Title or Position | CARDIOLOGIST
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Name | DR. VIYADA THONGOUTHAITHIP, M.D.
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Credential | M.D.
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Telephone | 503-297-8491
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD 12967
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License Number State | OR
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