Active NPI
Mikhail Izraylev
- Dentist
- Woodburn, OR
National Provider Identifier
1841066412
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D12015
- Practice address
- 1175 Mount Hood Ave
Woodburn, OR 97071-9060 - Phone
- (503) 982-2000
- NPI assigned
- Nov 27, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | D12015 | OR | |
| Dentist | 122300000X | D12015 | OR | Primary |
Addresses
Primary practice location
1175 Mount Hood Ave
Woodburn, OR 97071-9060
Mailing address
PO Box 190
Toppenish, WA 98948-0190
Phone (509) 865-2395
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250729004285 | OR | Order and Referring Only - Dentist | 8527575042 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1701043200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1752192000000",
"number": "1841066412",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 190",
"city": "TOPPENISH",
"state": "WA",
"postal_code": "989480190",
"telephone_number": "509-865-2395"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1175 MOUNT HOOD AVE",
"city": "WOODBURN",
"state": "OR",
"postal_code": "970719060",
"telephone_number": "503-982-2000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IZRAYLEV",
"first_name": "MIKHAIL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-11-27",
"last_updated": "2025-07-11",
"certification_date": "2025-07-11",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "OR",
"license": "D12015",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OR",
"license": "D12015",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Woodburn, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.