Provider Demographics
NPI:1659463511
Name:BUI, KIM L (MD)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:L
Last Name:BUI
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:PO BOX 4949
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-4949
Mailing Address - Country:US
Mailing Address - Phone:503-215-6446
Mailing Address - Fax:503-215-6644
Practice Address - Street 1:1003 PROVIDENCE DRIVE
Practice Address - Street 2:SUITE 210
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132
Practice Address - Country:US
Practice Address - Phone:503-537-5900
Practice Address - Fax:503-537-5959
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD22943208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR287574Medicaid
OR287574Medicaid
ORR136015Medicare PIN