Provider Demographics
NPI:1992986087
Name:SZETO, ERIK KWOKSHEK
Entity type:Individual
Prefix:
First Name:ERIK
Middle Name:KWOKSHEK
Last Name:SZETO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4130 SE DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-1647
Mailing Address - Country:US
Mailing Address - Phone:503-239-5836
Mailing Address - Fax:503-236-8326
Practice Address - Street 1:4130 SE DIVISION ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-1647
Practice Address - Country:US
Practice Address - Phone:503-239-5836
Practice Address - Fax:503-236-8326
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-17
Last Update Date:2007-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORORDO11884207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR217497Medicaid
R112592Medicare PIN
C90907Medicare UPIN