MEDICARE: KIRA SANDHU

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	R8360	OR
2	101YM0800X	Mental Health Counselor
3	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1740832369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRA SANDHU

Provider Business Mailing Address
First Line	:	1306 NW HOYT ST STE 407
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97209-2787
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	851 NE BAKER ST
Second Line	:
City	:	MCMINNVILLE
State	:	OR
Zip	:	97128-4991
Country	:	US
Telephone Number	:	503-435-4840
Fax Number	:	503-200-1416

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2019
Last Update Date	:	08/20/2025

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Directions to “ KIRA SANDHU ” Practice Location

Language	Start Address	Practice Location

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