MEDICARE: ASHOT SEDRAKYAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory		OR

General Provider Information

NPI Number	:	1417028598
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASHOT SEDRAKYAN

Provider Business Mailing Address
First Line	:	10175 SW BARBUR BLVD
Second Line	:	SUITE 105BA
City	:	PORTLAND
State	:	OR
Zip	:	97219-5908
Country	:	US
Telephone Number	:	503-977-2250
Fax Number	:

Provider Business Practice Location Address
First Line	:	10175 SW BARBUR BLVD
Second Line	:	SUITE 105BA
City	:	PORTLAND
State	:	OR
Zip	:	97219-5908
Country	:	US
Telephone Number	:	503-977-2250
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ASHOT SEDRAKYAN
Credential	:
Telephone Number	:	503-977-2250

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	08/22/2020

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