Healthcare Provider Details

I. General information

NPI: 1932737780
Provider Name (Legal Business Name): NITHYA PRATHIMA KOKA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2020
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3181 SW SAM JACKSON PARK RD
PORTLAND OR
97239-3011
US

IV. Provider business mailing address

3181 SW SAM JACKSON PARK RD
PORTLAND OR
97239-3011
US

V. Phone/Fax

Practice location:
  • Phone: 503-494-4300
  • Fax: 503-494-4323
Mailing address:
  • Phone: 503-494-4300
  • Fax: 503-494-4323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberMD220131
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: