Provider Demographics
NPI:1942362413
Name:NITTA, KENNETH MASAHIRO (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:MASAHIRO
Last Name:NITTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3987
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3987
Mailing Address - Country:US
Mailing Address - Phone:503-356-9166
Mailing Address - Fax:503-771-7221
Practice Address - Street 1:10123 SE MARKET ST
Practice Address - Street 2:DEPT. OF RADIATION ONCOLOGY
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2532
Practice Address - Country:US
Practice Address - Phone:503-251-6305
Practice Address - Fax:503-251-6802
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD147612085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR264648Medicaid
OR264648Medicaid
OR00WCHMRCMedicare PIN