Provider Demographics
NPI:1780855502
Name:VIYADA THONGOUTHAITHIP MD & CARMELINDO SIQUEIRA JR MD PC
Entity Type:Organization
Organization Name:VIYADA THONGOUTHAITHIP MD & CARMELINDO SIQUEIRA JR MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CARDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VIYADA
Authorized Official - Middle Name:
Authorized Official - Last Name:THONGOUTHAITHIP, M.D.
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-297-8491
Mailing Address - Street 1:9155 SW BARNES RD STE 310
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6630
Mailing Address - Country:US
Mailing Address - Phone:503-297-8491
Mailing Address - Fax:503-297-8492
Practice Address - Street 1:9155 SW BARNES RD STE 310
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6630
Practice Address - Country:US
Practice Address - Phone:503-297-8491
Practice Address - Fax:503-297-8492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD 12967174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR279174Medicaid
R0000WCGZKMedicare PIN