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General NPI Number Information
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NPI Number | 1881625820
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Entity Type | Organization
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Legal Business Name | MOUNTAIN PARK HEALTH CLINIC
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 11030 SW CAPITOL HWY SUITE 100
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City | PORTLAND
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State | OR
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Zip | 97219-8653
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Country | US
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Telephone | 503-892-9177
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Fax | 503-892-9177
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Provider Business Mailing Address
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Address Line | 11030 SW CAPITOL HWY SUITE 100
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City | PORTLAND
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State | OR
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Zip | 97219-8653
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Country | US
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Telephone | 503-892-9177
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Fax | 503-892-9177
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Authorized Official
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Title or Position | DR.
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Name | DR. KENNETH H. RIFKIN
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Credential | N.D., L.AC.
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Telephone | 503-892-8788
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number | 0423
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC00034
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License Number State | OR
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