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General NPI Number Information
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NPI Number | 1386164960
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Entity Type | Individual
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Provider Name | KEN A. NAKANOTE MD
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Gender | Male
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Dates
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Enumeration Date | 06/23/2017
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Last Update Date | 10/17/2024
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Provider Practice Location Address
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Address Line | 30 N 1900 E RM 1A071
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City | SALT LAKE CITY
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State | UT
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Zip | 84132-0002
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Country | US
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Telephone | 801-581-2868
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Fax |
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Provider Business Mailing Address
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Address Line | 3181 SW SAM JACKSON PARK RD OHSU MAIN HOSPITAL (11TH FLOOR)
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City | PORTLAND
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State | OR
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Zip | 97239-3011
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Country | US
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Telephone | 503-418-6725
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Fax | 503-346-8051
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 12229859-1205
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MD222332
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License Number State | OR
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