Individual
BRIAN KI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
7535 SW BARNES RD STE 111, PORTLAND, OR 97225-6269
(503) 764-9321
Mailing address
12843 SW VILLAGE PARK LN, TIGARD, OR 97223-7846
(503) 545-2422
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ATI-4296
OR
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
04/03/2016
Last updated
09/27/2021
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