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Individual
FELIX WIYANTO SIM
Active
Individual
FELIX WIYANTO SIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MBBS, BDS
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
FE172458
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
FE172458
OREGON MEDICAL LICENCE
OR
Enumeration date
07/07/2015
Last updated
07/07/2015
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