Individual
KHALIL I. SHASHA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
19300 SW 65TH AVE, TUALATIN, OR 97062-7706
(503) 413-8407
(503) 413-6951
Mailing address
PO BOX 3777, PORTLAND, OR 97208-3777
(503) 413-3900
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD00041482
WA
207R00000X
Internal Medicine Physician
Primary
MD173729
OR
208M00000X
Hospitalist Physician
MD00041482
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0279857
DEPT OF L&I
WA
05
—
1046292
—
WA
01
—
P00946005
RR MEDICARE
WA
Enumeration date
07/08/2006
Last updated
09/01/2020
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