Provider Demographics
NPI:1538603592
Name:GHATAN, KIAN
Entity type:Individual
Prefix:
First Name:KIAN
Middle Name:
Last Name:GHATAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16575 SW PENINSULA CT
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-7968
Mailing Address - Country:US
Mailing Address - Phone:503-839-1077
Mailing Address - Fax:
Practice Address - Street 1:1839 MOLALLA AVE
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-4071
Practice Address - Country:US
Practice Address - Phone:503-657-1483
Practice Address - Fax:503-657-1480
Is Sole Proprietor?:No
Enumeration Date:2016-12-10
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0015782183500000X
OR00157821835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist