Individual
KIM PHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
1130 SW MORRISON ST STE 450, PORTLAND, OR 97205-2276
(503) 227-4410
Mailing address
11410 SW LYNNVALE DRIVE, PORTLAND, OR 97225
(442) 226-9053
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
27405
CA
124Q00000X
Dental Hygienist
Primary
DH60350549
WA
124Q00000X
Dental Hygienist
H6453
OR
Other
Enumeration date
04/11/2015
Last updated
11/27/2020
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