Healthcare Provider Details

I. General information

NPI: 1184559890
Provider Name (Legal Business Name): JONATHAN KAISER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 MAIN ST STE 409
KLAMATH FALLS OR
97601-6064
US

IV. Provider business mailing address

905 MAIN ST STE 409
KLAMATH FALLS OR
97601-6064
US

V. Phone/Fax

Practice location:
  • Phone: 541-887-2344
  • Fax: 541-887-2291
Mailing address:
  • Phone: 541-887-2344
  • Fax: 541-887-2291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: