Individual
FELIX WIYANTO SIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MBBS, BDS
Contact information
Practice address
1015 NW 22ND AVE, PORTLAND, OR 97210-3025
(503) 413-4656
Mailing address
5710 SW GROVER CT, PORTLAND, OR 97221-1304
(503) 915-2879
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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