Individual
DR. SANDHYA V KOPPULA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
17200 NW CORRIDOR COURT, SUITE 112, BEAVERTON, OR 97006-3295
(503) 439-6969
(503) 439-6868
Mailing address
17200 NW CORRIDOR COURT, SUITE 112, BEAVERTON, OR 97006-3295
(503) 439-6969
(503) 439-6868
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
MD18825
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
075544
—
OR
05
—
8180424
—
WA
Enumeration date
12/09/2005
Last updated
11/03/2010
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