NPIMap

Organization Active NPI

Kaisky

  • Clinic/Center
  • McMinnville, OR
National Provider Identifier
1730856774
Registry record updated Oct 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
KAISKY
Practice address
2550 NE McDonald LN
McMinnville, OR 97128-2223
Phone
(503) 472-2181
NPI assigned
Aug 26, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2021

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

Authorized official

Name
Dr. Justin Todd Walter, DMDNPI 1265570873
Title
Owner
Phone
(503) 857-7026

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary
Dental Clinic/Center 261QD0000X

Addresses

Primary practice location

2550 NE McDonald LN
McMinnville, OR 97128-2223

Mailing address

1230 George St
Woodburn, OR 97071-5203
Phone (503) 981-3603

Other practice location 1

1230 George St
Woodburn, OR 97071-5203
Phone (503) 981-3603

National Provider Directory

National Provider Directory

Locations

2550 NE McDonald Ln
McMinnville, OR 97128
Phone (503) 472-2181

1230 George St
Woodburn, OR 97071
Phone (503) 981-3603

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1629936000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633651200000",
    "number": "1730856774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1230 GEORGE ST",
            "city": "WOODBURN",
            "state": "OR",
            "postal_code": "970715203",
            "telephone_number": "503-981-3603",
            "fax_number": "503-981-3604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2550 NE MCDONALD LN",
            "city": "MCMINNVILLE",
            "state": "OR",
            "postal_code": "971282223",
            "telephone_number": "503-472-2181"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1230 George St",
            "address_purpose": "LOCATION",
            "city": "Woodburn",
            "state": "OR",
            "postal_code": "970715203",
            "country_code": "US",
            "telephone_number": "503-981-3603",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "KAISKY",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-26",
        "last_updated": "2021-10-08",
        "certification_date": "2021-10-08",
        "status": "A",
        "authorized_official_last_name": "WALTER",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_middle_name": "TODD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-857-7026",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in McMinnville, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 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.