Provider Demographics
NPI:1720120975
Name:MIYAZONO, KAREN AIKO (LMT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:AIKO
Last Name:MIYAZONO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:KALENA
Other - Middle Name:AIKO
Other - Last Name:MIYAZONO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:4121 SE 73RD AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-3403
Mailing Address - Country:US
Mailing Address - Phone:503-730-6232
Mailing Address - Fax:
Practice Address - Street 1:15240 SE 82ND DR
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-9606
Practice Address - Country:US
Practice Address - Phone:503-656-5510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5901174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist