Provider Demographics
NPI:1457097479
Name:YNTIMATE LI OU LLC
Entity Type:Organization
Organization Name:YNTIMATE LI OU LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JONA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:CHWC; CD; NH; PF
Authorized Official - Phone:503-793-0977
Mailing Address - Street 1:10350 N VANCOUVER WAY # 1120
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-7530
Mailing Address - Country:US
Mailing Address - Phone:503-793-0977
Mailing Address - Fax:503-961-1946
Practice Address - Street 1:3080 NE MARTIN LUTHER KING JR BLVD APT 222
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-3189
Practice Address - Country:US
Practice Address - Phone:503-793-0977
Practice Address - Fax:503-961-1946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty
No374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty