Provider Demographics
NPI:1114963196
Name:YUTAN, PAUL U (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:U
Last Name:YUTAN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14110 GABRIELLE CT
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-5759
Mailing Address - Country:US
Mailing Address - Phone:503-314-7889
Mailing Address - Fax:
Practice Address - Street 1:14535 WESTLAKE DR STE B
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-7775
Practice Address - Country:US
Practice Address - Phone:503-479-5608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2025-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171100000X
ORMD24270207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR181616Medicaid
OR181616Medicaid
ORR114876Medicare PIN