Healthcare Provider Details

I. General information

NPI: 1619967460
Provider Name (Legal Business Name): ARIAN KARGAR DO
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 02/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 ST ANTHONY WAY
PENDLETON OR
97801-3836
US

IV. Provider business mailing address

2801 ST ANTHONY WAY
PENDLETON OR
97801
US

V. Phone/Fax

Practice location:
  • Phone: 541-966-0535
  • Fax: 541-966-2516
Mailing address:
  • Phone: 541-966-0535
  • Fax: 541-966-2516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20440
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: