Provider Demographics
NPI:1235025123
Name:KURAKULA, SAIE (LE)
Entity type:Individual
Prefix:
First Name:SAIE
Middle Name:
Last Name:KURAKULA
Suffix:
Gender:X
Credentials:LE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 NE 114TH AVE UNIT A
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-2252
Mailing Address - Country:US
Mailing Address - Phone:818-795-2450
Mailing Address - Fax:
Practice Address - Street 1:333 NE HANCOCK ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-3941
Practice Address - Country:US
Practice Address - Phone:818-795-2450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORBAP-E-10255940174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist