Active NPI
Kenneth Charles Goldberg, MD
- Public Health & General Preventive Medicine Physician
- Portland, OR
National Provider Identifier
1457669673
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Public Health & General Preventive Medicine Physician
- License
- MD16086
- Practice address
- 407 NE 12TH Ave
Ste 200
Portland, OR 97232 - Phone
- (503) 280-0880
- Fax
- (503) 232-7440
- NPI assigned
- Sep 22, 2010
- 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 |
|---|---|---|---|---|
| Public Health & General Preventive Medicine Physician | 2083P0901X | MD16086 | OR | Primary |
Addresses
Primary practice location
407 NE 12TH Ave
Ste 200
Portland, OR 97232
Mailing address
407 NE 12TH Ave
Ste 200
Portland, OR 97232
Phone (503) 280-0880
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD16086 | OR | MD | Public Health & General Preventive Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1285113600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1285113600000",
"number": "1457669673",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "407 NE 12TH AVE",
"address_2": "STE 200",
"city": "PORTLAND",
"state": "OR",
"postal_code": "97232",
"telephone_number": "503-280-0880",
"fax_number": "503-232-7440"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "407 NE 12TH AVE",
"address_2": "STE 200",
"city": "PORTLAND",
"state": "OR",
"postal_code": "97232",
"telephone_number": "503-280-0880",
"fax_number": "503-232-7440"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOLDBERG",
"first_name": "KENNETH",
"middle_name": "CHARLES",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-09-22",
"last_updated": "2010-09-22",
"status": "A"
},
"taxonomies": [
{
"code": "2083P0901X",
"taxonomy_group": "",
"desc": "Preventive Medicine, Public Health & General Preventive Medicine",
"state": "OR",
"license": "MD16086",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.