Provider Demographics
NPI:1396705414
Name:KINGSBURY, DANIEL JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JOSEPH
Last Name:KINGSBURY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 N GRAHAM ST STE 355
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-2005
Mailing Address - Country:US
Mailing Address - Phone:503-413-3930
Mailing Address - Fax:503-413-3948
Practice Address - Street 1:501 N GRAHAM ST STE 355
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-2005
Practice Address - Country:US
Practice Address - Phone:503-413-3930
Practice Address - Fax:503-413-3948
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD22287208000000X, 2080P0216X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0216XAllopathic & Osteopathic PhysiciansPediatricsPediatric Rheumatology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR288457Medicaid
OR288457Medicaid
OR113845Medicare ID - Type Unspecified