Individual
DR. SHANE K. KIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10819 SE STARK ST, SUITE 200, PORTLAND, OR 97216-3161
(503) 255-2291
(503) 252-1797
Mailing address
PO BOX 22009, PORTLAND, OR 97269-2009
(503) 558-7372
(503) 344-5140
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
MD27296
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
276174
—
OR
Enumeration date
11/02/2006
Last updated
02/20/2021
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