Sandhya V Koppula, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

MD18825 Issued in OR

Practice address

17200 NW Corridor Court
Suite 112
Beaverton, OR 97006-3295

Phone

(503) 439-6969

Fax

(503) 439-6868

NPI assigned

Dec 9, 2005

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Jan 1, 2020 through Jan 1, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1134086400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1288742400000",
    "number": "1962487231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17200 NW CORRIDOR COURT",
            "address_2": "SUITE 112",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970063295",
            "telephone_number": "503-439-6969",
            "fax_number": "503-439-6868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17200 NW CORRIDOR COURT",
            "address_2": "SUITE 112",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970063295",
            "telephone_number": "503-439-6969",
            "fax_number": "503-439-6868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOPPULA",
        "first_name": "SANDHYA",
        "middle_name": "V",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-12-09",
        "last_updated": "2010-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "OR",
            "license": "MD18825",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8180424",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "075544",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Theresa Ann Koenig, L.M.T.
• Naomi Koide-Gasser, LCSW
• Regina Kokoszka
• Kian Kolahi
• Melanie Kong-Shaw, M.A., B.C.B.A
• Kor Bodywork and Wellness LLC
• Sally Hafez Kordab, MD
• Tanya Kornuta, RDH
• Anna Koroteyev, RDH
• Andrea Noel Koskamp, DPT

• Dermatology Physician in Beaverton, OR
• Providers in Beaverton, OR by specialty
• Dermatology Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2010; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.