MEDICARE: LEENA YOUSSEFIAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	2084N0400X	Neurology Physician	MD61347684	WA
3	2084N0400X	Neurology Physician	MD211995	OR

General Provider Information

NPI Number	:	1376963959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEENA YOUSSEFIAN MD

Provider Business Mailing Address
First Line	:	PO BOX 3777
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97208-3777
Country	:	US
Telephone Number	:	503-413-3900
Fax Number	:	503-413-3710

Provider Business Practice Location Address
First Line	:	4101 SW HILLSDALE AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97239-1547
Country	:	US
Telephone Number	:	570-271-6144
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2014
Last Update Date	:	08/05/2025

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