Provider Demographics
NPI:1386982551
Name:KOHN, DAPHNA RIVAH (LAC)
Entity type:Individual
Prefix:
First Name:DAPHNA
Middle Name:RIVAH
Last Name:KOHN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1623 SE 50TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-3231
Mailing Address - Country:US
Mailing Address - Phone:503-358-0347
Mailing Address - Fax:
Practice Address - Street 1:117 NE 5TH ST
Practice Address - Street 2:SUITE E
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-4992
Practice Address - Country:US
Practice Address - Phone:503-548-7834
Practice Address - Fax:503-379-1548
Is Sole Proprietor?:No
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC161386171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist