# KPG OREGON, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1730552845
- **Authorized official:** DARRYL OLIVIER (COO)
- **Authorized official phone:** (310) 975-1450

## Contact information

- **Practice address:** 486 12TH STREET \#200, ASTORIA, OR 97103
- **Practice address phone:** (310) 975-1428
- **Mailing address:** 9000 SUNSET BLVD \#1500, WEST HOLLYWOOD, CA 90069
- **Mailing address phone:** (310) 975-1428

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RA0401X | Addiction Medicine (Internal Medicine) Physician | MD168198 | OR | Yes |

## Other

- **Enumeration date:** 11/11/2015
- **Last updated:** 04/12/2018