Individual provider Active NPI

Marykathryn Kordash

  • Student in an Organized Health Care Education/Training Program
  • Portland, OR
National Provider Identifier
1780335489
Registry record updated Jan 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
2775 NW 126TH Ave
Portland, OR 97229-8381
Phone
(971) 279-3377
NPI assigned
Jan 13, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 13, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

2775 NW 126TH Ave
Portland, OR 97229-8381

Mailing address

2775 NW 126TH Ave
Portland, OR 97229-8381
Phone (971) 279-3377

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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

Enrollment IDStateProvider typePAC IDDetails
I20250603002484 OR Order and Referring Only - PodiatryPractitioner - Podiatry 0042729832

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1642032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642032000000",
    "number": "1780335489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2775 NW 126TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972298381",
            "telephone_number": "971-279-3377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2775 NW 126TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972298381",
            "telephone_number": "971-279-3377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KORDASH",
        "first_name": "MARYKATHRYN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-01-13",
        "last_updated": "2022-01-13",
        "certification_date": "2022-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.