Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | MD203725 | OR |
NPI | 1023466182 |
---|---|
Provider Name | Dr. Audry Kang |
First Address | Portland, OR 97232-2686 |
Second Address | Gresham, OR 97030-3381 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2016 |
Last Update Date | 02/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
500791859 | (05) | OR |