MEDICARE: KODI BLAIR VAUGHAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist	H8994	OR

General Provider Information

NPI Number	:	1881551190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KODI BLAIR VAUGHAN

Provider Business Mailing Address
First Line	:	PO BOX 996
Second Line	:
City	:	DORRIS
State	:	CA
Zip	:	96023-0996
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5017 SOUTHVIEW DR
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97603-8545
Country	:	US
Telephone Number	:	541-903-9079
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/07/2026
Last Update Date	:	01/07/2026

Similar Medicare Providers

1447337068 — STEPHANIE GANSCHOW PHARMD
Practice Location Address:

2500 E 52ND ST N , CIGNA MEDICARE SERVICES
SIOUX FALLS, SD
57104-7106

Practice Phone: 605-373-0100
Practice Fax:

1730585670 — BRENNA RENAE CHAVARIN BS, EPDH
Practice Location Address:

5017 SOUTHVIEW DR
KLAMATH FALLS, OR
97603-8545

Practice Phone: 503-679-7527
Practice Fax:

1194486134 — BROOKE KEFFER EPDH
Practice Location Address:

5017 SOUTHVIEW DR
KLAMATH FALLS, OR
97603-8545

Practice Phone: 541-281-9737
Practice Fax:

1609683028 — KONNECT DENTAL KARE SERVICES
Practice Location Address:

5017 SOUTHVIEW DR
KLAMATH FALLS, OR
97603-8545

Practice Phone: 503-679-7527
Practice Fax:

1386053627 — PENNSBURY PHARMACY INC.
Practice Location Address:

8545 NEW FALLS RD
LEVITTOWN, PA
19054-1601

Practice Phone: 215-547-2378
Practice Fax:

1720673197 — KENNETH D LEE PHARMACIST
Practice Location Address:

8545 NEW FALLS RD
LEVITTOWN, PA
19054-1601

Practice Phone: 215-547-2378
Practice Fax:

Directions to “ KODI BLAIR VAUGHAN ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.