Provider Demographics
NPI:1871500702
Name:LU, KIM CHAMPION (MD)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:CHAMPION
Last Name:LU
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3181 SW SAM JACKSON PARK RD
Mailing Address - Street 2:MAILCODE L223A
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3011
Mailing Address - Country:US
Mailing Address - Phone:503-494-4373
Mailing Address - Fax:503-494-8884
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD
Practice Address - Street 2:MAILCODE L223A
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3011
Practice Address - Country:US
Practice Address - Phone:503-494-4373
Practice Address - Fax:503-494-8884
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2020-09-17
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Provider Licenses
StateLicense IDTaxonomies
ORMD25911208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR213553Medicaid
H28287Medicare UPIN