Provider Demographics
NPI:1548694433
Name:OGURA, KIYOKA (LAC)
Entity type:Individual
Prefix:
First Name:KIYOKA
Middle Name:
Last Name:OGURA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8835 SW 51ST AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-3373
Mailing Address - Country:US
Mailing Address - Phone:503-245-1196
Mailing Address - Fax:
Practice Address - Street 1:4530 SW HALL BLVD
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005
Practice Address - Country:US
Practice Address - Phone:503-913-6218
Practice Address - Fax:503-386-2224
Is Sole Proprietor?:No
Enumeration Date:2013-08-27
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC01054171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist