Provider Demographics
NPI:1104524495
Name:EMANENCE NATURAL MEDICINE
Entity type:Organization
Organization Name:EMANENCE NATURAL MEDICINE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ACUPUNCTURIST
Authorized Official - Prefix:DR
Authorized Official - First Name:YEDIDYA
Authorized Official - Middle Name:
Authorized Official - Last Name:TABANPOUR
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:347-509-6520
Mailing Address - Street 1:9118 SW MIDEA CT
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-2500
Mailing Address - Country:US
Mailing Address - Phone:917-678-3256
Mailing Address - Fax:503-673-2157
Practice Address - Street 1:407 NW 17TH AVE STE 5
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-2247
Practice Address - Country:US
Practice Address - Phone:347-509-6520
Practice Address - Fax:503-673-2157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-16
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty