Ivan John Konkin

Denturist · Portland, OR

Individual Active NPI

NPI number 1265067615

Practice location

12661 SE Powell Blvd Ste C
Portland, OR 97236-3400
Phone
(503) 655-4007

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NPI record

NPI
1265067615
Entity type
Individual (Type 1)
Enumeration date
March 5, 2020
Last updated
March 6, 2020
Certified
March 6, 2020
Sole proprietor
Yes

Specialties & taxonomy codes

TaxonomyCodeLicenseState
Denturist Primary 122400000X DT-DO-10204635 OR

About Ivan Konkin

Ivan John Konkin is a healthcare provider registered in the NPI registry with the primary taxonomy Denturist (code 122400000X). The practice location is 12661 SE Powell Blvd Ste C, Portland, OR 97236-3400. The NPI number 1265067615 was assigned on March 5, 2020 and the record was last updated on March 6, 2020.

Ivan Konkin lists a license in the registry: #DT-DO-10204635 (OR) for Denturist. License numbers are self-reported to NPPES; verify them with the state licensing board.

Frequently asked questions

What is the NPI number of Ivan John Konkin?

The NPI number is 1265067615.

What is the phone number of Ivan Konkin?

The phone number listed for the practice location is (503) 655-4007.

Where is Ivan Konkin located?

12661 SE Powell Blvd Ste C, Portland, OR 97236-3400.

What is the taxonomy code for Ivan Konkin?

The primary taxonomy code is 122400000X – Denturist.

Is this information correct?

All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.

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