KPG Oregon, LLC

Primary specialty

Addiction Medicine (Internal Medicine) PhysicianTaxonomy code 207RA0401X

License

MD168198 Issued in OR

Legal business name

KPG OREGON, LLC

Practice address

486 12TH Street #200
Astoria, OR 97103

Phone

(310) 975-1428

NPI assigned

Nov 11, 2015

Organization subpart

No

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

Authorized official

Name

Darryl Olivier

Title

Coo

Phone

(310) 975-1450

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1447200000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1523491200000",
    "number": "1730552845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9000 SUNSET BLVD #1500",
            "city": "WEST HOLLYWOOD",
            "state": "CA",
            "postal_code": "90069",
            "telephone_number": "310-975-1428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "486 12TH STREET #200",
            "city": "ASTORIA",
            "state": "OR",
            "postal_code": "97103",
            "telephone_number": "310-975-1428"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KPG OREGON, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-11",
        "last_updated": "2018-04-12",
        "status": "A",
        "authorized_official_last_name": "OLIVIER",
        "authorized_official_first_name": "DARRYL",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "310-975-1450"
    },
    "taxonomies": [
        {
            "code": "207RA0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Addiction Medicine",
            "state": "OR",
            "license": "MD168198",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leeanna Knight
• Emily Elizabeth Knutson, CD,CLC, CRM.
• John Joseph Kochanski IV
• Bret A. Koertge, PHARMD, PHD
• Milan Kopecky
• Debra Kumm, PHARMD.
• Melissa Ann Kuneki
• Katelyn Marie Kusey, PTA
• Laboratory Corporation of America
• Emily Laga

• Addiction Medicine (Internal Medicine) Physician in Astoria, OR
• Providers in Astoria, OR by specialty
• Addiction Medicine (Internal Medicine) Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2018; 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.