Provider Demographics
NPI:1144254194
Name:THONGOUTHAITHIP, VIYADA (MD)
Entity type:Individual
Prefix:DR
First Name:VIYADA
Middle Name:
Last Name:THONGOUTHAITHIP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9155 SW BARNES RD STE 310
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6630
Mailing Address - Country:US
Mailing Address - Phone:503-297-8491
Mailing Address - Fax:503-297-8492
Practice Address - Street 1:9155 SW BARNES RD STE 310
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6630
Practice Address - Country:US
Practice Address - Phone:503-297-8491
Practice Address - Fax:503-297-8492
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD 12967174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
93 0797900OtherTAX ID
OR24728-8Medicaid
ORD 73075Medicare UPIN
OR00WCGZKAMedicare PIN