Active NPI
Serhii Choban, LICENSED DENTURIST
- Denturist
- Portland, OR
National Provider Identifier
1841915600
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Denturist
- License
- DT-DO-10226552
- Practice address
- 11705 NE Glisan St
Portland, OR 97220-2141 - Phone
- (503) 922-5355
- NPI assigned
- Oct 4, 2022
- Last updated
- Oct 24, 2024
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Denturist | 122400000X | DT-DO-10226552 | OR | Primary |
Addresses
Primary practice location
11705 NE Glisan St
Portland, OR 97220-2141
Mailing address
11705 NE Glisan St
Portland, OR 97220-2141
Phone (503) 922-5355
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DT-DO-10226552 | OR | MD | Denturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1664841600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1729728000000",
"number": "1841915600",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11705 NE GLISAN ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972202141",
"telephone_number": "503-922-5355"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11705 NE GLISAN ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972202141",
"telephone_number": "503-922-5355"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHOBAN",
"first_name": "SERHII",
"name_prefix": "Mr.",
"credential": "LICENSED DENTURIST",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-10-04",
"last_updated": "2024-10-24",
"certification_date": "2024-10-24",
"status": "A"
},
"taxonomies": [
{
"code": "122400000X",
"taxonomy_group": "",
"desc": "Denturist",
"state": "OR",
"license": "DT-DO-10226552",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.