Healthcare Provider Details

I. General information

NPI: 1356036677
Provider Name (Legal Business Name): REN SHIRAI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2023
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18010 SW MCEWAN RD
LAKE OSWEGO OR
97035-7868
US

IV. Provider business mailing address

PO BOX 6689
PORTLAND OR
97228-6689
US

V. Phone/Fax

Practice location:
  • Phone: 503-525-7500
  • Fax:
Mailing address:
  • Phone: 503-413-3900
  • Fax: 503-413-3710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO228672
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: