Provider Demographics
NPI:1700403177
Name:SAECHAO, SARN TSIO
Entity Type:Individual
Prefix:
First Name:SARN
Middle Name:TSIO
Last Name:SAECHAO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15723 NE BEECH ST UNIT 3B
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-5176
Mailing Address - Country:US
Mailing Address - Phone:503-757-8960
Mailing Address - Fax:
Practice Address - Street 1:5329 NE MLK JR BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-3237
Practice Address - Country:US
Practice Address - Phone:503-988-3634
Practice Address - Fax:503-988-3839
Is Sole Proprietor?:No
Enumeration Date:2020-07-01
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0001930183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician