Provider Demographics
NPI:1366734808
Name:BUGAKOV, KRISTINE UYESUGI (MD)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:UYESUGI
Last Name:BUGAKOV
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 1:14279 S GLEN OAKS RD
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-8008
Mailing Address - Country:US
Mailing Address - Phone:503-657-7629
Mailing Address - Fax:503-557-8651
Practice Address - Street 1:14279 S GLEN OAKS RD
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-8008
Practice Address - Country:US
Practice Address - Phone:503-657-7629
Practice Address - Fax:503-557-8651
Is Sole Proprietor?:No
Enumeration Date:2011-05-03
Last Update Date:2021-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC172996208000000X
ORMD167908208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500672262Medicaid