Felix Wiyanto Sim
Oral & Maxillofacial Surgeon
1015 Nw 22nd Ave
Portland
, Oregon 97210-3025
Felix Wiyanto Sim
Oral & Maxillofacial Surgeon
1015 Nw 22nd Ave
Portland
, Oregon 97210-3025
(503) 915-2879
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About
Features
Specialties
- Oral & Maxillofacial Surgeon
Languages spoken
- English
Location
First Address
- Felix Wiyanto Sim
- 5710 Sw Grover Ct
- Portland, OR
- Zip : 97221-1304
- Phone : (503) 915-2879
Second Address
- Felix Wiyanto Sim
- 1015 Nw 22nd Ave
- Portland, OR
- Zip : 97210-3025
- Phone : (503) 413-4656
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 204E00000X | Oral & Maxillofacial Surgeon | FE172458 | OR |
National Provider Identifier
| NPI | 1104209386 |
|---|---|
| Provider Name | Felix Wiyanto Sim |
| First Address | Portland, OR 97221-1304 |
| Second Address | Portland, OR 97210-3025 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 07/07/2015 |
| Last Update Date | 07/07/2015 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| FE172458 | OREGON MEDICAL LICENCE (01) | OR |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.