Roozbeh Khosravi DMD PHD LLC

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

Legal business name

ROOZBEH KHOSRAVI DMD PHD LLC

Doing business as

Porth

Practice address

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

Phone

(425) 526-2060

NPI assigned

Oct 23, 2017

Organization subpart

No

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

Authorized official

Name

Dr. Roozbeh Khosravi, DMD PHD MSDNPI 1629433891

Title

Orthodontist

Phone

(617) 466-9090

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Porth Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Roozbeh Khosravi, DMD, PHD

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Sammamish, WA
  • NPI 1629433891
  NPD Authorized official

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

{
    "created_epoch": "1508716800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603411200000",
    "number": "1962913509",
    "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": {
        "organization_name": "ROOZBEH KHOSRAVI DMD PHD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-23",
        "last_updated": "2020-10-23",
        "certification_date": "2020-10-23",
        "status": "A",
        "authorized_official_last_name": "KHOSRAVI",
        "authorized_official_first_name": "ROOZBEH",
        "authorized_official_title_or_position": "ORTHODONTIST",
        "authorized_official_telephone_number": "617-466-9090",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD PHD MSD"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1629433891",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Porth",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Peter Riana, CB
• Janice Louise Rice, PAY.D
• Lisa Karen Ridley, RDH
• Amanda Robinson, LMP
• Marcela Rojas Valle
• John Marion Rossi, DDS
• Ryan Walker DDS PLLC
• Safeway Inc
• Sammamish Counseling
• Sammamish Diabetes and Lipid Clinic, PLLC

• 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 Oct 23, 2020; 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.