Soroush Amali

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D10530 Issued in OR

Practice address

7201 N Interstate Ave
Portland, OR 97217-5523

Phone

(503) 286-6868

NPI assigned

Apr 19, 2016

Last updated

Nov 2, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1461024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604275200000",
    "number": "1861846578",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2730 SW MOODY AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972015042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7201 N INTERSTATE AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972175523",
            "telephone_number": "503-286-6868"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2730 SW Moody Ave",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972015042",
            "country_code": "US",
            "telephone_number": "503-544-7573",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AMALI",
        "first_name": "SOROUSH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-04-19",
        "last_updated": "2020-11-02",
        "certification_date": "2020-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D10530",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• C a Leon Alzola, RPH
• Emmanuel Chukwuemeka Amadi, RPH
• Deron Trent Amador, M.D.
• Victoria Amador, F.N.P.
• Monica Kenzie Amadou Tidjani Abdou
• Amanda Antenucci Counseling LLC
• Amanda Tipton Stiller DC, LLC (Crossroads Chiropractic)
• Amani Foster Homes, LLC
• Sidney O Amankwah
• Edward Amann, RN

• General Practice Dentistry in Portland, OR
• Providers in Portland, OR by specialty
• General Practice Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2020; 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.

Verify at the official NPI Registry.