Organization
KPG OREGON, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DARRYL OLIVIER (COO)
(310) 975-1450
Entity
Organization
Contact information
Practice address
486 12TH STREET #200, ASTORIA, OR 97103
(310) 975-1428
Mailing address
9000 SUNSET BLVD #1500, WEST HOLLYWOOD, CA 90069
(310) 975-1428
Taxonomy
Speciality
Code
Description
License number
State
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
MD168198
OR
Other
Enumeration date
11/11/2015
Last updated
04/12/2018
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