Provider Demographics
NPI:1346731585
Name:TABANPOUR, YEDIDYA (ACUPUNCTURIST)
Entity Type:Individual
Prefix:MR
First Name:YEDIDYA
Middle Name:
Last Name:TABANPOUR
Suffix:
Gender:M
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9118 SW MIDEA CT
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-2500
Mailing Address - Country:US
Mailing Address - Phone:347-509-6520
Mailing Address - Fax:503-673-2157
Practice Address - Street 1:407 NW 17TH AVE # 5
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-2247
Practice Address - Country:US
Practice Address - Phone:347-509-6520
Practice Address - Fax:503-673-2157
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-23
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR187725171100000X, 171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist