Provider Demographics
NPI:1275264517
Name:KURI, KADIR JAMAL
Entity Type:Individual
Prefix:
First Name:KADIR
Middle Name:JAMAL
Last Name:KURI
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 1:1123 SE 148TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97233-2536
Mailing Address - Country:US
Mailing Address - Phone:725-777-8622
Mailing Address - Fax:
Practice Address - Street 1:1123 SE 148TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-2536
Practice Address - Country:US
Practice Address - Phone:725-777-8622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver