Dr. Kevin Gia-Minh Phan, OD
Optometrist in Happy Valley, OR. Individual provider (NPI-1).
NPI number1164065959
StatusActive
Last updated in NPPESSep 12, 2023
Details
- NPI
- 1164065959
- Entity type
- Individual (NPI-1)
- Name
- Dr. Kevin Gia-Minh Phan
- Credential
- OD
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Oct 24, 2019
- Certification date
- Sep 12, 2023
- Last updated
- Sep 12, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 152W00000X | Optometrist | 4708 | OR | Yes |
| 152W00000X | Optometrist | 60964432 | WA |
Practice location
12000 Se 82nd Ave Ste 2193Happy Valley, OR 97086-7746
Phone 503-654-6217 · Fax 503-654-9335
Mailing address
11084 Se 64th AvePortland, OR 97222-2319
Phone 503-890-7209
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