Individual
KEVIN MARK SENN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
707 SW GAINES ST., CDRC, PORTLAND, OR 97239-3098
(503) 494-1619
(503) 494-6868
Mailing address
707 SW GAINES ST., CDRC, PORTLAND, OR 97239-3098
(503) 494-1619
(503) 494-6868
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
183438
NY
2080P0006X
Developmental - Behavioral Pediatrics Physician
153312
OR
2080P0008X
Pediatric Neurodevelopmental Disabilities Physician
183438
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00010162101
UNIVERA
—
01
—
000511836003
BC/BS
—
05
—
0018547990001
—
PA
05
—
01402900
—
NY
01
—
040426000235
FIDELIS
—
01
—
040426000240
FIDELIS
—
01
—
1205731
IHA
—
01
—
183438
LICENSE
NY
Enumeration date
04/24/2006
Last updated
01/11/2011
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