Active NPI
Richard Henry Krokum, D.M.D
- Dentist
- Beaverton, OR
National Provider Identifier
1356598866
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 4337
- Practice address
- 14205 SW Allen Blvd
Beaverton, OR 97005-4406 - Phone
- (503) 646-7145
- Fax
- (503) 646-7146
- NPI assigned
- Aug 26, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 4337 | OR | Primary |
Addresses
Primary practice location
14205 SW Allen Blvd
Beaverton, OR 97005-4406
Mailing address
14205 SW Allen Blvd
Beaverton, OR 97005-4406
Phone (503) 646-7145
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4337 | OR | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1219708800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1219708800000",
"number": "1356598866",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14205 SW ALLEN BLVD",
"city": "BEAVERTON",
"state": "OR",
"postal_code": "970054406",
"telephone_number": "503-646-7145",
"fax_number": "503-646-7146"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14205 SW ALLEN BLVD",
"city": "BEAVERTON",
"state": "OR",
"postal_code": "970054406",
"telephone_number": "503-646-7145",
"fax_number": "503-646-7146"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KROKUM",
"first_name": "RICHARD",
"middle_name": "HENRY",
"name_prefix": "Dr.",
"credential": "D.M.D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-08-26",
"last_updated": "2008-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OR",
"license": "4337",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Beaverton, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.