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NPI Code Detail

MEDICARE: YANINA M BENIKOVA M.D.

MEDICARE: YANINA M BENIKOVA M.D.
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
1207Q00000XFamily Medicine PhysicianMD00037323WA
2207Q00000XFamily Medicine PhysicianMD21765OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1538115597
Entity Type Code : Individual
Provider Name (Legal Business Name) : YANINA M BENIKOVA M.D.
Provider Business Mailing Address
First Line : 19185 SW 90TH AVE
Second Line :
City : TUALATIN
State : OR
Zip : 97062-7558
Country : US
Telephone Number : 503-813-0377
Fax Number :
Provider Business Practice Location Address
First Line : 19185 SW 90TH AVE
Second Line :
City : TUALATIN
State : OR
Zip : 97062-7558
Country : US
Telephone Number : 503-813-0377
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/25/2006
Last Update Date : 02/04/2022

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Directions to “ YANINA M BENIKOVA M.D.” Practice Location

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