Individual
KEVIN MA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5909 SE 92ND AVE, PORTLAND, OR 97266-4642
(503) 771-0055
Mailing address
5909 SE 92ND AVE, PORTLAND, OR 97266-4642
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD61578733
WA
Other
Enumeration date
04/30/2021
Last updated
02/10/2026
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