Healthcare Provider Details

I. General information

NPI: 1902215965
Provider Name (Legal Business Name): KAIVON ASGHARIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2014
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 SW GREENBURG RD STE 200
TIGARD OR
97223-5490
US

IV. Provider business mailing address

9900 SW GREENBURG RD STE 200
PORTLAND OR
97223-5490
US

V. Phone/Fax

Practice location:
  • Phone: 971-251-1557
  • Fax:
Mailing address:
  • Phone: 971-251-1557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: