Provider Demographics
NPI:1144288267
Name:SHIRAZI, SIAMAK F (LAC, DOM (CANADA))
Entity type:Individual
Prefix:
First Name:SIAMAK
Middle Name:F
Last Name:SHIRAZI
Suffix:
Gender:M
Credentials:LAC, DOM (CANADA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5935 WILLOW LN
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-5344
Mailing Address - Country:US
Mailing Address - Phone:503-655-0044
Mailing Address - Fax:503-515-8099
Practice Address - Street 1:5935 WILLOW LN
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-5344
Practice Address - Country:US
Practice Address - Phone:503-655-0044
Practice Address - Fax:503-515-8099
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00307171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist