Provider Demographics
NPI:1275829129
Name:BAJEMA, KRISTINA LYN (MD)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:LYN
Last Name:BAJEMA
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 1:3181 SW SAM JACKSON PARK RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3011
Mailing Address - Country:US
Mailing Address - Phone:503-494-7735
Mailing Address - Fax:503-494-4264
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3011
Practice Address - Country:US
Practice Address - Phone:503-494-7735
Practice Address - Fax:503-494-4264
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60531626207R00000X, 207RI0200X
ORMD205354207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500666866Medicaid
WA1275829129Medicaid
ORR174264Medicare PIN
ORR174946Medicare PIN
ORR174267Medicare PIN
OR500666866Medicaid
ORR174268Medicare PIN