Provider Demographics
NPI:1841994001
Name:BHAN, SONIA ASHIKA
Entity type:Individual
Prefix:
First Name:SONIA
Middle Name:ASHIKA
Last Name:BHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6120 N MONTANA AVE UNIT A
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-4785
Mailing Address - Country:US
Mailing Address - Phone:661-855-3390
Mailing Address - Fax:
Practice Address - Street 1:2505 SW SPRING GARDEN ST STE 100
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-3966
Practice Address - Country:US
Practice Address - Phone:503-470-5443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR26408225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist