Provider Demographics
NPI:1194465153
Name:FESEHA, AYAHUN
Entity Type:Individual
Prefix:
First Name:AYAHUN
Middle Name:
Last Name:FESEHA
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 1:4666 NE 116TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-1421
Mailing Address - Country:US
Mailing Address - Phone:503-860-3592
Mailing Address - Fax:
Practice Address - Street 1:4666 NE 116TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-1421
Practice Address - Country:US
Practice Address - Phone:503-860-3592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)