JACOB TANG (NPI# 1790176006) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790176006 |
| Entity Type | Individual |
| Full Name | JACOB TANG |
| Practice Address |
1940 Se 12th Ave Apt 9 Portland OR 97214-4779 |
| Mailing Address |
1940se 12th, No. 9 Portland OR 97214 |
| Practice Telephone | 5032311043 |
| Mailing Telephone | 5032311043 |
| Enumeration Date | 2015-02-09 |
| Last Update Date | 2015-02-09 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1835P0018X |
Pharmacist Specialization: Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
6788 | OR | Pharmacy Service Providers |
| Street Address |
1940 SE 12TH AVE APT 9 |
| City | PORTLAND |
| State | OR |
| Zip Code | 97214-4779 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538773155 | Mamie Nzigire Zagabe | Peer Specialist | 605 Se Cesar Estrada Chavez Blvd, Portland, OR 97214 | 2020-09-01 |
| 1336772243 | Alexandra Mcbryde | Acupuncturist | 959 Se Division St, #315, Portland, OR 97214 | 2020-02-19 |
| 1356973770 | Laura Kille | Counselor | Wise Counsel and Comfort, 2045 Se Hawthorne Blvd., Portland, OR 97214 | 2020-02-05 |
| 1639616436 | Erin Elizabeth Weaver | Acupuncturist | 1330 Se Cesar E Chavez Blvd. Center for Natural Meidici, Portland, OR 97214 | 2017-01-31 |
| 1780126045 | Katherine Aravamudan, Lpc, LLC | Community/Behavioral Health | 1312 E. Burnside Street, Portland, OR 97214 | 2016-11-17 |
| 1003358441 | Michelle Jean Meadows | Massage Therapist | 2804 Se Lincoln St, Portland, OR 97214 | 2016-11-16 |
| 1629429311 | Stephanie Tolentino | Counselor | 605 Se Cesar E Chavez Blvd., Portland, OR 97214 | 2016-06-24 |
| 1790141166 | Marian Iris Dixon | Massage Therapist | 3810 Se Belmont St., Earthbody Wellness Center East, Portland, OR 97214 | 2016-01-14 |
| 1194194589 | Lutheran Community Services Northwest | Community/Behavioral Health | 605 Se Cesar E Chavez Bld, Portland, OR 97214 | 2015-09-16 |
| 1497123566 | Michele R. Stokes | Specialist | 2311 East Burnside B1, Portland, OR 97214 | 2015-09-08 |
| Find all providers in zip 97214 | ||||
| Taxonomy Code | 1835P0018X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| Specialization | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
| Pharmacist Clinician/Clinical Pharmacy Specialist is a pharmacist with additional training and an expanded scope of practice that may include prescriptive authority, therapeutic management, and disease management. |
| Notes: Source: National Uniform Claim Committee, 2007 [1/1/2008: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588178701 | Daniel Hendrickson | Pharmacist | 503 Sw 5th Avenue, Portland, OR 97204 | 2017-11-27 |
| 1336662204 | Jenny French | Pharmacist | 9427 Sw Barnes Rd Ste 295, Portland, OR 97225-6652 | 2017-07-21 |
| 1104378199 | Derek Andrus | Pharmacist | 5717 Nw 138th, Portland, OR 97230 | 2016-10-26 |
| 1245695956 | M. Katherine Welch | Pharmacist | 3228 Sw Water Ave, Portland, OR 97239-4632 | 2015-12-22 |
| 1902211196 | Danit Chetron | Pharmacist | 2323 Sw Caldew St, Portland, OR 97219-2618 | 2014-06-25 |
| 1023350881 | Joey Goren Degrood | Pharmacist | 9044 Sw Rystadt Ln, Portland, OR 97225-2851 | 2013-03-20 |
| 1831435213 | James L Huang | Pharmacist | 300 N Graham St Ste 200, Portland, OR 97227 | 2012-12-12 |
| 1972853331 | Sharon Leigh | Pharmacist | 4531 Se Belmont St. Suite 100, Portland, OR 97215-1675 | 2012-09-13 |
| 1649544107 | Ryan Bradley | Pharmacist | 6348 Ne Halsey St Ste A, Portland, OR 97213-4720 | 2012-03-01 |
| 1285907915 | Michele Karen Koder | Pharmacist | 3529 Ne Martin Luther King, Jr. Blvd., Portland, OR 97211 | 2012-02-10 |
| Find all providers in PORTLAND | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.