Provider Demographics
NPI:1841674280
Name:NORTHWEST EAR INSTITUTE PC
Entity type:Organization
Organization Name:NORTHWEST EAR INSTITUTE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:HYON SOO
Authorized Official - Middle Name:HAROLD
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-444-7676
Mailing Address - Street 1:2230 NW PETTYGROVE ST
Mailing Address - Street 2:STE. 120
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-2659
Mailing Address - Country:US
Mailing Address - Phone:503-444-7676
Mailing Address - Fax:971-319-6647
Practice Address - Street 1:2230 NW PETTYGROVE ST
Practice Address - Street 2:STE. 120
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2659
Practice Address - Country:US
Practice Address - Phone:503-444-7676
Practice Address - Fax:971-319-6647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-15
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD24993207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & NeurotologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR139873Medicare PIN
ORP00636169Medicare UPIN