Healthcare Provider Details

I. General information

NPI: 1265034987
Provider Name (Legal Business Name): KNOW ALLERGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2020
Last Update Date: 11/09/2020
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2275 W BURNSIDE ST
PORTLAND OR
97210-3541
US

IV. Provider business mailing address

12575 NE MARX ST
PORTLAND OR
97230-1058
US

V. Phone/Fax

Practice location:
  • Phone: 503-297-4779
  • Fax: 503-297-0499
Mailing address:
  • Phone: 503-297-4779
  • Fax: 503-297-0499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number State

VIII. Authorized Official

Name: KURSTEEN PRICE
Title or Position: PRESIDENT
Credential: MD
Phone: 360-254-4316