Provider Demographics
NPI:1528643657
Name:SASAO-RUEF, BRADLEY JAMES (LAC)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:JAMES
Last Name:SASAO-RUEF
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:BRADLEY
Other - Middle Name:JAMES
Other - Last Name:SASAO-RUEF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:1110 SE ALDER ST STE 110
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-2400
Mailing Address - Country:US
Mailing Address - Phone:971-417-6205
Mailing Address - Fax:
Practice Address - Street 1:1110 SE ALDER ST STE 110
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-2400
Practice Address - Country:US
Practice Address - Phone:971-417-6205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-10
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC203559171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500840197Medicaid