Provider Demographics
NPI:1346274115
Name:BEAN, KENNETH ALAN (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:ALAN
Last Name:BEAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 SW 9TH ST
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914-2639
Mailing Address - Country:US
Mailing Address - Phone:541-881-7001
Mailing Address - Fax:541-881-7186
Practice Address - Street 1:351 SW 9TH ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-2639
Practice Address - Country:US
Practice Address - Phone:541-881-7001
Practice Address - Fax:541-881-7186
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT61333271205207PE0004X
ORMD40242207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807461000Medicaid
H40242Medicare UPIN
I40242Medicare UPIN