Provider Demographics
NPI:1699218925
Name:UNDONO CARE PORTLAND 1, LLC
Entity Type:Organization
Organization Name:UNDONO CARE PORTLAND 1, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRINH
Authorized Official - Middle Name:
Authorized Official - Last Name:DO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-954-3219
Mailing Address - Street 1:2850 SE 82ND AVE UNIT 8
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-1599
Mailing Address - Country:US
Mailing Address - Phone:503-954-3219
Mailing Address - Fax:503-387-5223
Practice Address - Street 1:2850 SE 82ND AVE UNIT 8
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-1599
Practice Address - Country:US
Practice Address - Phone:503-954-3219
Practice Address - Fax:503-387-5223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-18
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty