Provider Demographics
NPI:1376265256
Name:PURE JOY PEDIATRICS LLC
Entity Type:Organization
Organization Name:PURE JOY PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIRIN
Authorized Official - Middle Name:N
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-420-8667
Mailing Address - Street 1:355 NW ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-6256
Mailing Address - Country:US
Mailing Address - Phone:503-420-8667
Mailing Address - Fax:971-512-3246
Practice Address - Street 1:15405 SW 116TH AVE STE 116
Practice Address - Street 2:
Practice Address - City:KING CITY
Practice Address - State:OR
Practice Address - Zip Code:97224-2600
Practice Address - Country:US
Practice Address - Phone:503-420-8667
Practice Address - Fax:971-512-3246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-16
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty