Provider Demographics
NPI:1275803850
Name:SARAH FRANCES BUTLER FAN
Entity Type:Organization
Organization Name:SARAH FRANCES BUTLER FAN
Other - Org Name:YOUNG PINE ACUPUNCTURE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:FRANCES BUTLER
Authorized Official - Last Name:FAN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:503-877-5633
Mailing Address - Street 1:12750 SW 2ND ST STE 102
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-2779
Mailing Address - Country:US
Mailing Address - Phone:503-877-5633
Mailing Address - Fax:503-350-1470
Practice Address - Street 1:12750 SW 2ND ST STE 102
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-2779
Practice Address - Country:US
Practice Address - Phone:503-877-5633
Practice Address - Fax:503-350-1470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-12
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR153088171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1073817748OtherNPI TYPE 1