Provider Demographics
NPI:1093208134
Name:SJOREN, KENNETH LEIF NATHANIEL (DO)
Entity type:Individual
Prefix:DR
First Name:KENNETH LEIF
Middle Name:NATHANIEL
Last Name:SJOREN
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1441 NE 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:PAYETTE
Mailing Address - State:ID
Mailing Address - Zip Code:83661-5420
Mailing Address - Country:US
Mailing Address - Phone:208-642-9376
Mailing Address - Fax:208-642-9598
Practice Address - Street 1:840 SW 4TH AVE STE 105
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-2638
Practice Address - Country:US
Practice Address - Phone:541-881-2800
Practice Address - Fax:541-881-2825
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-13
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO219324207V00000X
IDO-1672207V00000X
MI5151010352207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology