Provider Demographics
NPI:1770650194
Name:VU, KIM CHI (MD)
Entity Type:Individual
Prefix:DR
First Name:KIM CHI
Middle Name:
Last Name:VU
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 1:15390 NW CORNELL RD
Mailing Address - Street 2:SUITE 225
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-5627
Mailing Address - Country:US
Mailing Address - Phone:503-601-2910
Mailing Address - Fax:503-601-2914
Practice Address - Street 1:15390 NW CORNELL RD
Practice Address - Street 2:SUITE 225
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-5627
Practice Address - Country:US
Practice Address - Phone:503-601-2910
Practice Address - Fax:503-601-2914
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2015-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD24426174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR124415Medicare UPIN