Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080N0001X | Neonatal-Perinatal Doctor | MD155237 | OR |
Y | 2080N0001X | Neonatal-Perinatal Doctor | MD60457125 | WA |
NPI | 1043470057 |
---|---|
Provider Name | Amanda Kim |
First Address | Portland, OR 97239-2901 |
Second Address | Portland, OR 97239-3011 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2008 |
Last Update Date | 23/12/2021 |