Individual
HEIDI KJOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3101 SE 192ND AVE, SUITE 106, VANCOUVER, WA 98683-1442
(360) 729-8010
(360) 729-8011
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
MD153026
OR
207Q00000X
Family Medicine Physician
Primary
MD60200769
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500631081
—
OR
01
—
P00946521
RR MEDICARE
WA
Enumeration date
10/03/2005
Last updated
02/12/2025
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