Kenneth A Whittaker, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

MD19011 Issued in OR

Practice address

506 N Villa Rd
Newberg, OR 97132-1833

Phone

(503) 554-0036

Fax

(503) 538-9257

NPI assigned

Oct 2, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Providence Health & Services - Oregon

  dba Providence Newberg Medical Center

  • General Acute Care Hospital
  • Newberg, OR
  • NPI 1952482275
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623715200000",
    "number": "1073606687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "506 N VILLA RD",
            "city": "NEWBERG",
            "state": "OR",
            "postal_code": "971321833",
            "telephone_number": "503-554-0036",
            "fax_number": "503-538-9257"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "506 N VILLA RD",
            "city": "NEWBERG",
            "state": "OR",
            "postal_code": "971321833",
            "telephone_number": "503-554-0036",
            "fax_number": "503-538-9257"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITTAKER",
        "first_name": "KENNETH",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2021-06-15",
        "certification_date": "2021-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OR",
            "license": "MD19011",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "081448",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Robert James Weniger, PSYD
• Tara Weston, LMT
• Laura Wheaton, M.S.
• Viva Wheaton, PSY.D.
• Amethyst White, FNP-C
• Mary Teresa Wikander, LCSW
• Timothy P Wilcox, LMT
• Kelsey Wilde, DPT
• Robert Carl Wilde, DMD
• Hannah Elisabeth Wiley, LMT

• Pediatrics Physician in Newberg, OR
• Providers in Newberg, OR by specialty
• Pediatrics Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.