Provider Demographics
NPI:1316030927
Name:KEMALYAN, NATHAN ARTHUR (MD)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:ARTHUR
Last Name:KEMALYAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:847 NE 19TH AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2684
Mailing Address - Country:US
Mailing Address - Phone:503-963-2801
Mailing Address - Fax:503-963-2825
Practice Address - Street 1:6485 SW BORLAND RD
Practice Address - Street 2:STE B
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-9762
Practice Address - Country:US
Practice Address - Phone:503-468-3222
Practice Address - Fax:458-888-0891
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD15679208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1316030927Medicaid
OR70722Medicaid
ORE74940Medicare UPIN
00WCBDGBMedicare ID - Type Unspecified
OR70722Medicaid