Provider Demographics
NPI:1740517325
Name:EDNA KUNG, MD, PC
Entity type:Organization
Organization Name:EDNA KUNG, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-734-5381
Mailing Address - Street 1:2456 NW NORTHRUP ST
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3253
Mailing Address - Country:US
Mailing Address - Phone:503-241-5117
Mailing Address - Fax:503-243-6632
Practice Address - Street 1:2456 NW NORTHRUP ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3253
Practice Address - Country:US
Practice Address - Phone:503-241-5117
Practice Address - Fax:503-243-6632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-03
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD27996207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty