Kim K Erickson, DMD, MD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

D6905 Issued in OR

Practice address

511 10TH Ave Suite 808
Portland, OR 97205-4661

Phone

(503) 289-9621

Fax

(503) 289-2930

NPI assigned

Jan 21, 2006

Sex

Female

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 FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1137801600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576022400000",
    "number": "1881674042",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "511 SW 10TH AVE SUITE 808",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97205",
            "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": "511 10TH AVE SUITE 808",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972054661",
            "telephone_number": "503-289-9621",
            "fax_number": "503-289-2930"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "926 Franklin Ave",
            "address_purpose": "LOCATION",
            "city": "Lemoore",
            "state": "CA",
            "postal_code": "932460001",
            "country_code": "US",
            "telephone_number": "559-998-4220",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "405 SE 133rd Ave",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "97233",
            "country_code": "US",
            "telephone_number": "855-433-6825",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8931 SE Foster Rd",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972664661",
            "country_code": "US",
            "telephone_number": "855-433-6825",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ERICKSON",
        "first_name": "KIM",
        "middle_name": "K",
        "credential": "DMD, MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-21",
        "last_updated": "2019-12-11",
        "certification_date": "2019-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "OR",
            "license": "D6905",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Graham Barclay Erickson, O.D.
• Hailey Erin Erickson, MS, QMHP
• Jane Lee Erickson, LPC
• Jasper Erickson, MD
• Katherine M Erickson, MD
• Kristin A Erickson
• Mark Erickson, D.C., M.SC
• Molly Janezich Erickson, LAC
• Neil Erickson
• Shelby Rae Erickson

• 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 Dec 11, 2019; 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.