Ivan John Konkin
Denturist
12661 Se Powell Blvd Ste C
Portland
, Oregon 97236-3400
(503) 655-4007
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About
Features
Language(s) Spoken
English
Ethnic Identity
White / Caucasian
Specialties
- Denturist
Languages spoken
- English
Location
First Address
- Ivan John Konkin
- 12661 Se Powell Blvd Ste C
- Portland, OR
- Zip : 97236-3400
- Phone : (503) 655-4007
Second Address
- Ivan John Konkin
- 12661 Se Powell Blvd Ste C
- Portland, OR
- Zip : 97236-3400
- Phone : (503) 655-4007
Reviews
FAQs
Where did Ivan John Konkin attend graduate school?
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Where did Ivan John Konkin do his residency?
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Where did Ivan John Konkin do his fellowship?
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Is Ivan John Konkin board certified?
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What type of doctor is Ivan John Konkin
Denturist
In what state does Ivan John Konkin practice in?
Oregon
Where is Ivan John Konkin ’s practice located?
12661 Se Powell Blvd Ste C , Portland, Oregon, 97236-3400
What is Ivan John Konkin ’s gender?
Male
Is Ivan John Konkin a sole practitioner?
No
Is Ivan John Konkin accepting new patients?
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What languages does Ivan John Konkin speak?
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Does Ivan John Konkin accept insurance?
Yes, Ivan John Konkin accepts insurance
Does Ivan John Konkin offers telemedicine?
Ivan John Konkin has not indicated if he offers telemedicine
What is Ivan John Konkin ’s professional license number?
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What is Ivan John Konkin ’s NPI number?
1265067615
Does Ivan John Konkin have any license restrictions?
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 122400000X | Denturist | DT-DO-10204635 | OR |
National Provider Identifier
| NPI | 1265067615 |
|---|---|
| Provider Name | Ivan John Konkin |
| First Address | Portland, OR 97236-3400 |
| Second Address | Portland, OR 97236-3400 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 05/03/2020 |
| Last Update Date | 06/03/2020 |
NPI Footnotes
What is the National Provider Identifier (NPI)
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.
Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.
Entity Type Code
The code describing the type of health care provider that is being assigned an NPI. The entity type codes are:
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers.
Subpart examples include: Hospital components include outpatient departments, surgical centers,
psychiatric units, and laboratories. These components are often separately licensed or certified by
States and may exist at physical locations other than that of the hospital of which they are a
component.
Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if
an individual) or other name by which the organization provider is or has been known. The code
identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.
Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI)
Last Update Date
The date that a NPI record was last updated or changed
Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPls the license data is associated to the taxonomy code.
Authorized Official Name
The name of the person authorized to submit the PI application or to officially change data for a health care provider.