Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DT - DO- 1005743 | OR |
NPI | 1992918361 |
---|---|
Provider Name | Kristine S. Bahng |
First Address | Beaverton, OR 97005-2603 |
Second Address | Beaverton, OR 97005-2603 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2007 |
Last Update Date | 08/07/2007 |