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Individual

DR. VIYADA THONGOUTHAITHIP

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
9155 SW BARNES RD STE 310, PORTLAND, OR 97225-6630
(503) 297-8491
(503) 297-8492
Mailing address
9155 SW BARNES RD STE 310, PORTLAND, OR 97225-6630
(503) 297-8491
(503) 297-8492

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MD 12967
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
24728-8
OR
01
93 0797900
TAX ID
Enumeration date
07/10/2006
Last updated
06/02/2008
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