Unknown Individual – Dermatology Physician, NPI 1396941530

Unknown Individual is a healthcare provider. based in Clackamas, Oregon. specializing in Dermatology Physician. They hold a License No. MD09756 (OR). The NPI Number for Unknown Individual is 1396941530

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1396941530
Phone
Not provided
Address
9775 SE SUNNYSIDE RD
Deactivation Date
9 September 2022
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 9775, Southeast Sunnyside Road, Harmony, Oatfield, Metro, Clackamas County, Oregon, 97015, United States

    SUITE 500

    CLACKAMAS, OR 970155739

    Phone:

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

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Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 97015)

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Reviews

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Frequently asked questions

Can I cross-check Unknown Individual using NPI 1396941530?
NPI 1396941530 belongs to Unknown Individual; compare other details if you need extra assurance.
Does inactive status mean Unknown Individual stopped practicing?
Inactive registry status can reflect deactivation, consolidation, or data lag.
What kind of doctor is Unknown Individual?
Unknown Individual is associated with Dermatology Physician in the directory — Clinical services aligned with this taxonomy classification.
Where in Oregon is Unknown Individual registered?
Use Clackamas, Oregon as the headline location for Unknown Individual here.
When was this NPI issued?
Enumeration for Unknown Individual is noted as not shown in this record where the registry provides it.

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