1154070084 NPI number — KLEIMAN HEALTHCARE SERVICES

Table of content: (NPI 1154070084)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154070084 NPI number — KLEIMAN HEALTHCARE SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KLEIMAN HEALTHCARE SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154070084
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
415 N STATE ST STE 136
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE OSWEGO
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97034-3243
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-951-3450
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19365 SW 65TH AVE STE 205
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUALATIN
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97062-9196
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-427-0588
Provider Business Practice Location Address Fax Number:
503-376-5064
Provider Enumeration Date:
03/19/2022

Additional Information

Authorized Official

Authorized Official Last Name:
KLEIMAN
Authorized Official First Name:
NAZENEEM
Authorized Official Middle Name:
S
Authorized Official Title or Position:
NURSE PRACTITIONER/PRESIDENT
Authorized Official Telephone Number:
310-951-3450

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1497396899 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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