Roozbeh Khosravi, DMD, PHD

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

DE60504324 Issued in WA

Practice address

22620 SE 4TH St Ste 210
Sammamish, WA 98074-7375

Phone

(425) 526-2060

NPI assigned

Dec 15, 2015

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Roozbeh Khosravi DMD PHD LLC

  dba Porth

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Sammamish, WA
  • NPI 1962913509
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1450137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1629433891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22620 SE 4TH ST STE 210",
            "city": "SAMMAMISH",
            "state": "WA",
            "postal_code": "980747375",
            "telephone_number": "425-526-2060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22620 SE 4TH ST STE 210",
            "city": "SAMMAMISH",
            "state": "WA",
            "postal_code": "980747375",
            "telephone_number": "425-526-2060"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "14655 NE Bel Red Rd # F103",
            "address_purpose": "LOCATION",
            "city": "Bellevue",
            "state": "WA",
            "postal_code": "980073900",
            "country_code": "US",
            "telephone_number": "425-526-2060",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KHOSRAVI",
        "first_name": "ROOZBEH",
        "name_prefix": "Dr.",
        "credential": "DMD, PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-12-15",
        "last_updated": "2022-07-21",
        "certification_date": "2020-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "WA",
            "license": "DE60504324",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kcaba LLC
• Terry L Keene, ARNP
• Alaba Tosin Kehinde
• Shana Rene Kenzler Olmstead, MA, LMHCA
• Ketan Jumani DDS PLLC
• Angela Lynn Kiel, LMP
• Caroline Konstantinovna Kifa
• Luba Kihichak, MD
• Anna Haeun Kim Douglass, LICSW
• Yuri Kim, PHARMD

• Orthodontics and Dentofacial Orthopedics Dentistry in Sammamish, WA
• Providers in Sammamish, WA by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.