Active NPI
Alex Kwak, RN
- Addiction (Substance Use Disorder) Registered Nurse
- Portland, OR
National Provider Identifier
1750806964
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Registered Nurse
- License
- 201705197RN
- Practice address
- 1312 SW Washington St
Portland, OR 97205-2327 - Phone
- (503) 535-1151
- NPI assigned
- Aug 8, 2017
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Registered Nurse | 163WA0400X | 201705197RN | OR | Primary |
Addresses
Primary practice location
1312 SW Washington St
Portland, OR 97205-2327
Mailing address
PO Box 3007
Portland, OR 97208-3007
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
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 201705197RN | OR | MD | Addiction (Substance Use Disorder) Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1502150400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1502150400000",
"number": "1750806964",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3007",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972083007"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1312 SW WASHINGTON ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972052327",
"telephone_number": "503-535-1151"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KWAK",
"first_name": "ALEX",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-08-08",
"last_updated": "2017-08-08",
"status": "A"
},
"taxonomies": [
{
"code": "163WA0400X",
"taxonomy_group": "",
"desc": "Registered Nurse, Addiction (Substance Use Disorder)",
"state": "OR",
"license": "201705197RN",
"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 Aug 8, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.