Provider Demographics
NPI:1083011431
Name:VEJO, KEMAL
Entity Type:Individual
Prefix:
First Name:KEMAL
Middle Name:
Last Name:VEJO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3633 SE 35TH PL
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-3370
Mailing Address - Country:US
Mailing Address - Phone:503-494-1468
Mailing Address - Fax:503-494-6143
Practice Address - Street 1:3633 SE 35TH PL
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-3370
Practice Address - Country:US
Practice Address - Phone:503-494-1468
Practice Address - Fax:503-494-6143
Is Sole Proprietor?:No
Enumeration Date:2014-12-01
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator