Provider Demographics
NPI:1255308631
Name:ILIAIFAR, SAKINEH X (MD)
Entity Type:Individual
Prefix:
First Name:SAKINEH
Middle Name:
Last Name:ILIAIFAR
Suffix:X
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24800 SE STARK ST
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-3378
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24900 SE STARK ST
Practice Address - Street 2:SUITE #110
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-3355
Practice Address - Country:US
Practice Address - Phone:503-465-6850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD24647207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Not Answered207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
G70334Medicare UPIN
OR133741Medicare ID - Type Unspecified