Provider Demographics
NPI:1417028598
Name:ASHOT SEDRAKYAN
Entity Type:Organization
Organization Name:ASHOT SEDRAKYAN
Other - Org Name:PURE QUALITY LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHOT
Authorized Official - Middle Name:
Authorized Official - Last Name:SEDRAKYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-977-2250
Mailing Address - Street 1:10175 SW BARBUR BLVD
Mailing Address - Street 2:SUITE 105BA
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-5908
Mailing Address - Country:US
Mailing Address - Phone:503-977-2250
Mailing Address - Fax:
Practice Address - Street 1:10175 SW BARBUR BLVD
Practice Address - Street 2:SUITE 105BA
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-5908
Practice Address - Country:US
Practice Address - Phone:503-977-2250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory