Provider Demographics
NPI:1376630285
Name:CHEN-JOHNSTON, CAROL I (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:I
Last Name:CHEN-JOHNSTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:503-537-6026
Mailing Address - Fax:503-537-6027
Practice Address - Street 1:1003 PROVIDENCE DRIVE
Practice Address - Street 2:SUITE 325
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-7521
Practice Address - Country:US
Practice Address - Phone:503-537-6026
Practice Address - Fax:503-537-6027
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-104651207RC0000X
ORMD153235207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease