Healthcare Provider Details

I. General information

NPI: 1710672852
Provider Name (Legal Business Name): RIA SANDHU DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2023
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 NE STUCKI AVE STE 300
BEAVERTON OR
97006-6945
US

IV. Provider business mailing address

1925 NE STUCKI AVE STE 300
BEAVERTON OR
97006-6945
US

V. Phone/Fax

Practice location:
  • Phone: 503-220-8262
  • Fax:
Mailing address:
  • Phone: 503-220-8262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number8586
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: