Provider Demographics
NPI:1447328398
Name:DOUZDJIAN, VIKEN (MD)
Entity type:Individual
Prefix:
First Name:VIKEN
Middle Name:
Last Name:DOUZDJIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 NW 22ND AVE
Mailing Address - Street 2:NSC #430
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3057
Mailing Address - Country:US
Mailing Address - Phone:503-413-6722
Mailing Address - Fax:503-413-6563
Practice Address - Street 1:1040 NW 22ND AVE
Practice Address - Street 2:NSC #430
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3057
Practice Address - Country:US
Practice Address - Phone:503-413-6722
Practice Address - Fax:503-413-6563
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD23071208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8295412Medicaid
OR287293Medicaid
OR111119Medicare ID - Type Unspecified
WA8295412Medicaid