Jan Andrew Kooning, DMD PC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

D6081 Issued in OR

Practice address

3549 N Lombard
Portland, OR 97217-5901

Phone

(503) 289-9621

Fax

(503) 289-2930

NPI assigned

Jul 31, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Columbia Park Oral Surgery PC

  • Oral and Maxillofacial Surgery (Dentist)
  • Portland, OR
  • NPI 1639103658
  NPD (past) Authorized official

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

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1770599144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3549 N LOMBARD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972175901",
            "telephone_number": "503-289-9621",
            "fax_number": "503-289-2930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3549 N LOMBARD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972175901",
            "telephone_number": "503-289-9621",
            "fax_number": "503-289-2930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOONING",
        "first_name": "JAN",
        "middle_name": "ANDREW",
        "name_prefix": "Mr.",
        "credential": "DMD PC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "OR",
            "license": "D6081",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David C Koon, M.D.
• Rebecca Koon
• Varonica L Koon, MSW
• Christine Marie Koonce, PMHNP
• Lorenzo Koonce
• Joria Valene Koons, RD, RDH
• Kristin Koontz, RPH
• Maxfield Koontz
• Kailey Ann Koopman, DC
• Matthew C. Koopmann, M.D.

• Oral and Maxillofacial Surgery (Dentist) in Portland, OR
• Providers in Portland, OR by specialty
• Oral and Maxillofacial Surgery (Dentist) in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.