Healthcare Provider Details

I. General information

NPI: 1922011832
Provider Name (Legal Business Name): KAISER PERMANENTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 06/01/2021
Certification Date: 06/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 NE GRAND AVE
PORTLAND OR
97232-1127
US

IV. Provider business mailing address

235 THUNDERBIRD ST
MOLALLA OR
97038-8315
US

V. Phone/Fax

Practice location:
  • Phone: 503-280-2877
  • Fax: 503-331-3095
Mailing address:
  • Phone: 503-829-8183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH2051
License Number StateOR

VIII. Authorized Official

Name: MRS. SHARON LYNNE BROWN
Title or Position: REGISTERED DENTAL HYGIENIST
Credential: RDH
Phone: 503-280-2877