=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548951593
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AAKASH KISHORE, PH.D., LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2023
-----------------------------------------------------
Last Update Date | 05/18/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2705 E BURNSIDE ST STE 206
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97214-1768
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-208-6301
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2705 E BURNSIDE ST STE 206
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97214-1768
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-208-6301
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL PSYCHOLOGIST
-----------------------------------------------------
Name | DR. SAANJH AAKASH KISHORE
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 503-208-6301
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------