Provider Demographics
NPI:1386031649
Name:JAFFE, KATHLEEN BALAZY (MD, MPH)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:BALAZY
Last Name:JAFFE
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:KATY
Other - Middle Name:ELIZABETH
Other - Last Name:BALAZY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, MPH
Mailing Address - Street 1:3620 N INTERSTATE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1106
Mailing Address - Country:US
Mailing Address - Phone:800-813-2000
Mailing Address - Fax:
Practice Address - Street 1:KAISER PERMANENTE INTERSTATE RADIATION ONCOLOGY
Practice Address - Street 2:3620 N INTERSTATE AVE
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-9722
Practice Address - Country:US
Practice Address - Phone:503-280-2931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-23
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD.MD.611489042085R0001X
OR2039752085R0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program