FELIX WIYANTO SIM (NPI# 1104209386) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104209386 |
| Entity Type | Individual |
| Full Name | FELIX WIYANTO SIM |
| Credential | MBBS, BDS |
| Practice Address |
1015 Nw 22nd Ave Portland OR 97210-3025 |
| Mailing Address |
5710 Sw Grover Ct Portland OR 97221-1304 |
| Practice Telephone | 5034134656 |
| Mailing Telephone | 5039152879 |
| Enumeration Date | 2015-07-07 |
| Last Update Date | 2015-07-07 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 204E00000X | Oral & Maxillofacial Surgery | FE172458 | OR | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | OREGON MEDICAL LICENCE | FE172458 | 01 |
| Street Address |
1015 NW 22ND AVE |
| City | PORTLAND |
| State | OR |
| Zip Code | 97210-3025 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467449629 | Chen-wen Christopher Heh | Psychiatry & Neurology | 1015 Nw 22nd Ave, Portland, OR 97210-3025 | 2005-10-03 |
| 1023620770 | Jenelle Lynn Stinson | Pharmacist | 1015 Nw 22nd Ave, Portland, OR 97210-3025 | 2020-08-22 |
| 1821618935 | Jena Jobin | Pharmacist | 1015 Nw 22nd Ave, Portland, OR 97210-3025 | 2020-04-17 |
| 1164041810 | Danielle Amelie Parker | Occupational Therapist | 1015 Nw 22nd Ave, Portland, OR 97210-3025 | 2020-04-13 |
| 1659910362 | Ellen Lee | Nurse Anesthetist, Certified Registered | 1015 Nw 22nd Ave, Portland, OR 97210-3025 | 2019-12-27 |
| 1487291787 | Nicholai Leon Mathewson | Nurse Anesthetist, Certified Registered | 1015 Nw 22nd Ave, Portland, OR 97210-3025 | 2019-12-05 |
| 1528603438 | Lap Huy Nguyen | Pharmacist | 1015 Nw 22nd Ave, Portland, OR 97210-3025 | 2019-11-14 |
| 1649814617 | Ethan Andrew Blashford | Pharmacist | 1015 Nw 22nd Ave, Portland, OR 97210-3025 | 2019-11-03 |
| 1770127854 | Meri Leah Grotzinger | Pharmacist | 1015 Nw 22nd Ave, Portland, OR 97210-3025 | 2019-11-01 |
| 1467095307 | Dennis Thompson | Pharmacist | 1015 Nw 22nd Ave, Portland, OR 97210-3025 | 2019-10-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679109086 | Joseph Francolino | Massage Therapist | 2174 Nw Davis Street, Apartment 105, Portland, OR 97210 | 2020-03-17 |
| 1215574058 | Northwest Dbt LLC | Psychologist | 2230 Nw Pettygrove St., Suite 130, Portland, OR 97210 | 2019-11-27 |
| 1649769480 | Dipesh Patel | Student in an Organized Health Care Education/Training Program | 1200 Nw 23rd Ave. Legacy Clinic Good Samaritan, Portland, OR 97210 | 2018-05-08 |
| 1760987234 | Meghan Teague | Student in an Organized Health Care Education/Training Program | Legacy Good Samaritan Medical Center- Gme, 1015 Nw 22nd Ave, Portland, OR 97210 | 2018-03-27 |
| 1205349172 | Paul M Storm | Acupuncturist | 1708 Nw 25th Ave. Apt. #6, Portland, OR 97210 | 2017-11-14 |
| 1740703750 | Audra K Berning | Massage Therapist | 2122 Nw Quimby, Root Whole Body, Portland, OR 97210 | 2017-07-21 |
| 1720539810 | Anna-marie Elizabeth Wood | Audiologist | 2222 Nw Lovejoy St Ste 662, Portland, OR 97210 | 2016-10-24 |
| 1659829836 | H&s Pearl, LLC | Massage Therapist | 25 Nw 23rd Pl, Suite 7, Portland, OR 97210 | 2016-09-15 |
| 1255785796 | Cortez Natural Medicine, Inc. | Acupuncturist | 2230 Nw Pettygove Street, Unit 130, Portland, OR 97210 | 2016-04-21 |
| 1932563616 | Vincent Chen | Student in an Organized Health Care Education/Training Program | 1200 Nw 23rd Avenue, Legacy Clinic Good Samaritan, Portland, OR 97210 | 2016-04-08 |
| Find all providers in zip 97210 | ||||
| Taxonomy Code | 204E00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Oral & Maxillofacial Surgery |
| Oral and maxillofacial surgeons are trained to recognize and treat a wide spectrum of diseases, injuries and defects in the head, neck, face, jaws and the hard and soft tissues of the oral and maxillofacial region. They are also trained to administer anesthesia, and provide care in an office setting. They are trained to treat problems such as the extraction of wisdom teeth, misaligned jaws, tumors and cysts of the jaw and mouth, and to perform dental implant surgery. |
| Notes: Source: American College of Surgeons, 2013. www.facs.org [7/1/2013: definition added, source added, additional resources added] Additional Resources: American Board of Oral and Maxillofacial Surgery and American Association of Oral and Maxillofacial Surgeons While this is generally considered a specialty of dentistry, physicians can also be board certified as oral and maxillofacial surgeons through the American Board of Oral and Maxillofacial Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346249281 | Bryce Earl Potter | Oral & Maxillofacial Surgery | 1849 Nw Kearney St, Ste 300, Portland, OR 97209-1453 | 2005-07-20 |
| 1053864561 | Karl Cuddy | Oral & Maxillofacial Surgery | 2801 N Gantenbein Ave, Portland, OR 97227-1623 | 2016-08-01 |
| 1407109937 | Providence Health & Services - Oregon | Oral & Maxillofacial Surgery | 4805 Ne Glisan St, Suite 6n50, Portland, OR 97213-2933 | 2012-10-22 |
| 1447525852 | Brett A. Ueeck Dmd, Md, PC | Oral & Maxillofacial Surgery | 11786 Sw Barnes Rd Ste 110, Portland, OR 97225-5926 | 2012-03-19 |
| 1588939961 | Marcus Aaron Couey | Oral & Maxillofacial Surgery | 1849 Nw Kearney St Ste 300, Portland, OR 97209-1453 | 2012-03-18 |
| 1043537707 | Allen C Cheng | Oral & Maxillofacial Surgery | 1849 Nw Kearney St, Suite 300, Portland, OR 97209 | 2010-04-21 |
| 1043415870 | Ashish A Patel | Oral & Maxillofacial Surgery | 1849 Nw Kearney St, Suite 300, Portland, OR 97209 | 2007-06-20 |
| 1235332834 | Daniel Petrisor | Oral & Maxillofacial Surgery | 3181 Sw Sam Jackson Park Rd, Portland, OR 97239-3011 | 2007-06-09 |
| 1790889376 | Maine Medical Partners | Oral & Maxillofacial Surgery | 22 Bramhall St, Dept of Surgery, Portland, ME 04102-3134 | 2006-09-12 |
| 1841208303 | Thomas William Albert | Oral & Maxillofacial Surgery | 3181 Sw Sam Jackson Park Rd, Portland, OR 97239-3011 | 2006-08-03 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.