Individual
KATHY KIRYANG BAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
12400 NW CORNELL RD STE 100, PORTLAND, OR 97229-5689
(503) 291-4000
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
A91888
CA
207Q00000X
Family Medicine Physician
Primary
MD164294
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500674133
—
OR
Enumeration date
07/20/2006
Last updated
10/27/2023
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