Provider Demographics
NPI:1790806149
Name:KAMADA, DANIEL KEN (PMHNP)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:KEN
Last Name:KAMADA
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 SE 223RD AVE
Mailing Address - Street 2:STE 204
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-7454
Mailing Address - Country:US
Mailing Address - Phone:503-661-7733
Mailing Address - Fax:503-661-7890
Practice Address - Street 1:333 SE 223RD AVE
Practice Address - Street 2:STE 204
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-7454
Practice Address - Country:US
Practice Address - Phone:503-661-7733
Practice Address - Fax:503-661-7890
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR077038738N6363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health