Doctor Name: | KRISTINE S. BAHNG |
NPI Number: | 1992918361 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LD |
License Number: | DT - DO- 1005743 |
Business Practice Address: | 13751 Sw Farmington Rd Beaverton, OR - 970052603 |
Business Phone Number: | 5035029108 |
Business Fax Number: | |
Mailing Address: | 13751 Sw Farmington Rd, BEAVERTON |
State: | OR |
Postal Code: | 970052603 |
Phone Number: | 5035029108 |
Fax Number: | |
NPI Enumeration Date: | 05/08/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 122400000X |
License Number: | DT - DO- 1005743 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OR |
Taxonomy Type: | Dental Providers |
Taxonomy Classification: | Denturist |
Taxonomy Specialization: | |
Taxonomy Definition: |