Provider Demographics
NPI:1013055664
Name:JINNAH, KEIVAN A (ND, LAC)
Entity Type:Individual
Prefix:DR
First Name:KEIVAN
Middle Name:A
Last Name:JINNAH
Suffix:
Gender:M
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3007 SE BELMONT ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-4026
Mailing Address - Country:US
Mailing Address - Phone:503-445-7115
Mailing Address - Fax:503-445-7116
Practice Address - Street 1:3701 SE MILWAUKIE AVE STE F
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-3835
Practice Address - Country:US
Practice Address - Phone:503-239-7341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00393171100000X
OR0972175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist