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NPI Code Detail

MEDICARE: KASSY DOBSON RD, LD, CDCES

MEDICARE: KASSY DOBSON RD, LD, CDCES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered Dietitian86082295OR

General Provider Information

NPI Number : 1114450947
Entity Type Code : Individual
Provider Name (Legal Business Name) : KASSY DOBSON RD, LD, CDCES
Provider Business Mailing Address
First Line : 501 N GRAHAM ST
Second Line :
City : PORTLAND
State : OR
Zip : 97227-1654
Country : US
Telephone Number : 503-410-1600
Fax Number :
Provider Business Practice Location Address
First Line : 7886 SE 13TH AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97202-6300
Country : US
Telephone Number : 503-956-9396
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/08/2017
Last Update Date : 11/05/2025

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Directions to “ KASSY DOBSON RD, LD, CDCES” Practice Location

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