Healthcare Provider Details

I. General information

NPI: 1730508169
Provider Name (Legal Business Name): BENJAMIN RICHARD KAFKA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2014
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2485 12TH ST SE
SALEM OR
97302-2151
US

IV. Provider business mailing address

2485 12TH ST SE
SALEM OR
97302-2151
US

V. Phone/Fax

Practice location:
  • Phone: 503-399-1386
  • Fax: 503-399-1182
Mailing address:
  • Phone: 503-399-1386
  • Fax: 503-399-1182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberMD2079733
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: