Healthcare Provider Details

I. General information

NPI: 1700853173
Provider Name (Legal Business Name): NANCY KAHANER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 08/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5415 SE MILWAUKIE AVE SUITE 1
PORTLAND OR
97202-4940
US

IV. Provider business mailing address

5203 SE 35TH AVE
PORTLAND OR
97202-4119
US

V. Phone/Fax

Practice location:
  • Phone: 503-233-6622
  • Fax: 503-233-9988
Mailing address:
  • Phone: 503-771-1360
  • Fax: 503-777-1351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberDO 15080
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: