Provider Demographics
NPI:1972901601
Name:KASS, STEPHANE
Entity Type:Individual
Prefix:
First Name:STEPHANE
Middle Name:
Last Name:KASS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STEPHANE
Other - Middle Name:
Other - Last Name:KASS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD
Mailing Address - Street 1:57 NE WYGANT ST
Mailing Address - Street 2:5
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-2759
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3710 SW US VETERANS HOSPITAL RD
Practice Address - Street 2:NUTRITION AND FOOD SERVICES (P-5 NFS) #1034
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-2964
Practice Address - Country:US
Practice Address - Phone:503-220-8262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-11
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLDD10164586133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered