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General NPI Number Information
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NPI Number | 1851787394
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Entity Type | Individual
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Provider Name | KIM PHAN RDH
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Gender | Female
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Dates
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Enumeration Date | 04/11/2015
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Last Update Date | 11/27/2020
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Provider Practice Location Address
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Address Line | 1130 SW MORRISON ST STE 450
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City | PORTLAND
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State | OR
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Zip | 97205-2276
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Country | US
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Telephone | 503-227-4410
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Fax |
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Provider Business Mailing Address
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Address Line | 11410 SW LYNNVALE DRIVE
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City | PORTLAND
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State | OR
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Zip | 97225
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Country | US
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Telephone | 442-226-9053
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 27405
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | H6453
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | DH60350549
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License Number State | WA
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