Healthcare Provider Details

I. General information

NPI: 1598200180
Provider Name (Legal Business Name): AARON KLEIN CPNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2017
Last Update Date: 06/30/2022
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8645 SE SUNNYBROOK BLVD STE 200
CLACKAMAS OR
97015-6841
US

IV. Provider business mailing address

8645 SE SUNNYBROOK BLVD STE 200
CLACKAMAS OR
97015-6841
US

V. Phone/Fax

Practice location:
  • Phone: 503-659-1694
  • Fax: 503-659-8984
Mailing address:
  • Phone: 503-659-1694
  • Fax: 503-659-8984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number201810561NP-PP
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP60997794
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: