Individual
MR. KEN TAKENAKA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC, LAT, OTC
Contact information
Practice address
11782 SW BARNES RD STE 300, PORTLAND, OR 97225-5933
(503) 214-5200
(503) 906-6613
Mailing address
11782 SW BARNES RD STE 300, PORTLAND, OR 97225-5933
(035) 214-5200
(503) 901-6661
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT10145051
OR
246ZX2200X
Orthopedic Assistant
050802325
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ATAT10145051
ATC LICENSE
OR
Enumeration date
07/29/2008
Last updated
06/23/2023
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