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1184959629

NPI Code Detail

MEDICARE: MRS. KENDRA ELISE NGUYEN MD

MEDICARE: MRS. KENDRA ELISE NGUYEN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	MD150844	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184959629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KENDRA ELISE NGUYEN MD

Provider Business Mailing Address
First Line	:	4938 SW 1ST AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97239-2883
Country	:	US
Telephone Number	:	503-730-5556
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 DIVISION ST
Second Line	:	SUITE 280
City	:	OREGON CITY
State	:	OR
Zip	:	97045-1527
Country	:	US
Telephone Number	:	503-905-3400
Fax Number	:	503-905-3399

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/15/2009
Last Update Date	:	02/04/2022

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Directions to “ MRS. KENDRA ELISE NGUYEN MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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