Provider Demographics
NPI:1629060348
Name:KDKN INC
Entity Type:Organization
Organization Name:KDKN INC
Other - Org Name:CASCADE HEARING AID CENTER, GORGE FAMILY AUDIOLOGY, ADAM'S HEARING CEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-386-1666
Mailing Address - Street 1:1501 13TH ST
Mailing Address - Street 2:
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-1924
Mailing Address - Country:US
Mailing Address - Phone:541-386-1666
Mailing Address - Fax:541-386-1594
Practice Address - Street 1:1501 13TH ST
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-1924
Practice Address - Country:US
Practice Address - Phone:541-386-1666
Practice Address - Fax:541-386-1594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR22567237600000X
ORHAS-P-151421237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Not Answered237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR023038Medicaid
OR130600Medicare ID - Type Unspecified
OR023038Medicaid