Provider Demographics
NPI:1518286871
Name:YOUNG, KRISTINA HOOT (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:HOOT
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:DR
Other - First Name:KRISTINA
Other - Middle Name:ELAINE
Other - Last Name:HOOT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:541 NE 20TH AVE STE 225
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2895
Mailing Address - Country:US
Mailing Address - Phone:503-963-2801
Mailing Address - Fax:503-963-2825
Practice Address - Street 1:4805 NE GLISAN ST
Practice Address - Street 2:GARDEN LEVEL
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2933
Practice Address - Country:US
Practice Address - Phone:503-215-6029
Practice Address - Fax:503-215-6387
Is Sole Proprietor?:No
Enumeration Date:2010-05-26
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD1712542085R0001X, 2085R0001X
ORPG151546390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500653472Medicaid
OR181252Medicare PIN