Individual
PROMPORN PAULA WICHIENKUER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5050 NE HOYT ST, SUITE 540, PORTLAND, OR 97213-2991
(503) 215-6600
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD152342
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500624437
—
OR
01
—
P00965916
RR MEDICARE
OR
Enumeration date
05/08/2007
Last updated
03/25/2021
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