Provider Demographics
NPI:1164552626
Name:LAU, KENDRICK MK (MD)
Entity Type:Individual
Prefix:
First Name:KENDRICK
Middle Name:MK
Last Name:LAU
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:426 SW STARK ST
Mailing Address - Street 2:8TH FLOOR
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97204-2347
Mailing Address - Country:US
Mailing Address - Phone:503-988-3674
Mailing Address - Fax:503-988-3676
Practice Address - Street 1:426 SW STARK ST
Practice Address - Street 2:8TH FLOOR
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-2347
Practice Address - Country:US
Practice Address - Phone:503-988-3674
Practice Address - Fax:503-988-3676
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
ORMC18847207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORG58850Medicare UPIN