Healthcare Provider Details

I. General information

NPI: 1255308631
Provider Name (Legal Business Name): SAKINEH ILIAIFAR X MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24900 SE STARK ST SUITE #110
GRESHAM OR
97030-3355
US

IV. Provider business mailing address

24800 SE STARK ST
GRESHAM OR
97030-3378
US

V. Phone/Fax

Practice location:
  • Phone: 503-465-6850
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMD24647
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD24647
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: