Provider Demographics
NPI:1366677411
Name:AZIZKHANI, ANA (LAC)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:
Last Name:AZIZKHANI
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2274 NW RALEIGH ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210
Mailing Address - Country:US
Mailing Address - Phone:503-323-0453
Mailing Address - Fax:
Practice Address - Street 1:2274 NW RALEIGH ST
Practice Address - Street 2:SUITE 3
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2766
Practice Address - Country:US
Practice Address - Phone:503-323-0453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC01294171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist