Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 0972 | OR |
NPI | 1013055664 |
---|---|
Provider Name | Dr. Keivan A. Jinnah |
First Address | Portland, OR 97214-4026 |
Second Address | Portland, OR 97202-3835 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2007 |
Last Update Date | 03/04/2018 |