FELIX WIYANTO SIM MBBS BDS NPI 1104209386

NPI Information

  • NPI: 1104209386
  • Provider Name: FELIX WIYANTO SIM, MBBS, BDS
  • Classification: Oral & Maxillofacial Surgery - 204E00000X
  • Entity Type: Individual
  • Address: 1015 NW 22ND AVE
    PORTLAND, OR
    ZIP 97210
  • Phone: (503) 413-4656

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NPI Details

Felix Wiyanto Sim, MBBS, BDS is an oral maxillofacial surgery in Portland, OR. The provider is 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. Felix Wiyanto Sim, MBBS, BDS NPI is 1104209386. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

1015 NW 22ND AVE
PORTLAND, OR
ZIP 97210-025
Phone: (503) 413-4656

The enumeration date for this NPI number is 7/7/2015 and was last updated on 7/7/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1204E00000XOral & Maxillofacial SurgeryFE172458OREGONYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1FE172458OTHEROREGONOREGON MEDICAL LICENCE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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