Provider Demographics
NPI:1235542622
Name:RAHIMI, JALEH MIKO (MD)
Entity Type:Individual
Prefix:
First Name:JALEH
Middle Name:MIKO
Last Name:RAHIMI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JALEH
Other - Middle Name:M
Other - Last Name:OLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:503-215-6494
Mailing Address - Fax:
Practice Address - Street 1:1321 NE 99TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-9439
Practice Address - Country:US
Practice Address - Phone:503-215-4250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-04
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAML 60470557207Q00000X
ORMD184080207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine