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General NPI Number Information
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NPI Number | 1528499910
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Entity Type | Individual
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Provider Name | ELAN KENNEDY
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Gender | Male
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Dates
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Enumeration Date | 12/10/2013
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Last Update Date | 04/08/2021
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Provider Practice Location Address
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Address Line | 3181 SW SAM JACKSON PARK RD., MAIL CODE L353 OHSU, DIVISION OF CARDIOTHORACIC SURGERY
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City | PORTLAND
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State | OR
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Zip | 97239
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Country | US
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Telephone | 503-494-7820
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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., MAIL CODE L353 OHSU, DIVISION OF CARDIOTHORACIC SURGERY
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City | PORTLAND
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State | OR
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Zip | 97239
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Country | US
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Telephone | 503-494-7820
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Fax |
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 055-0031496
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License Number State | VT
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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