Healthcare Provider Details

I. General information

NPI: 1821401423
Provider Name (Legal Business Name): KIRA BENDIXEN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2014
Last Update Date: 10/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 KANAKANAK RD
DILLINGHAM AK
99576-0130
US

IV. Provider business mailing address

PO BOX 130
DILLINGHAM AK
99576-0130
US

V. Phone/Fax

Practice location:
  • Phone: 907-842-5201
  • Fax: 907-842-9250
Mailing address:
  • Phone: 907-842-9218
  • Fax: 907-842-9250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number135348
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: