Healthcare Provider Details

I. General information

NPI: 1578474151
Provider Name (Legal Business Name): KIEFFER KATZ
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E MCLOUGHLIN BLVD
VANCOUVER WA
98663-3358
US

IV. Provider business mailing address

4027 N COLONIAL AVE
PORTLAND OR
97227-1009
US

V. Phone/Fax

Practice location:
  • Phone: 360-281-6824
  • Fax:
Mailing address:
  • Phone: 310-869-4004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
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: