Individual
KATHY KHONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
1300 SW 6TH AVE STE 150, PORTLAND, OR 97201-3529
(971) 200-8428
(971) 269-2905
Mailing address
1300 SW 6TH AVE, SUITE 150, PORTLAND, OR 97201-3464
(971) 200-8428
(971) 269-2905
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3360ATI
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
32086
REGENCE BLUE CROSS BLUE SHIELD
OR
05
—
500630758
—
OR
Enumeration date
06/03/2010
Last updated
06/03/2013
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