Provider Demographics
NPI: | 1003943382 |
---|---|
Name: | KU, NATALIE (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | NATALIE |
Middle Name: | |
Last Name: | KU |
Suffix: | |
Gender: | F |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 8317 NW HAZELTINE ST |
Mailing Address - Street 2: | |
Mailing Address - City: | PORTLAND |
Mailing Address - State: | OR |
Mailing Address - Zip Code: | 97229-4182 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 503-291-6019 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 335 SE 8TH AVE |
Practice Address - Street 2: | |
Practice Address - City: | HILLSBORO |
Practice Address - State: | OR |
Practice Address - Zip Code: | 97123-4246 |
Practice Address - Country: | US |
Practice Address - Phone: | 503-681-1000 |
Practice Address - Fax: | 503-681-1796 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2007-02-27 |
Last Update Date: | 2010-11-09 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
OR | MD23116 | 2085R0202X, 2085R0204X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No | 2085R0204X | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
OR | 292267 | Medicaid | |
OR | 292267 | Medicaid | |
OR | R111926 | Medicare ID - Type Unspecified | PROVIDER NO. |