Provider Demographics
NPI:1346914272
Name:DARAEE, KYAHN
Entity Type:Individual
Prefix:
First Name:KYAHN
Middle Name:
Last Name:DARAEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5934 S CORBETT AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3710
Mailing Address - Country:US
Mailing Address - Phone:971-272-4898
Mailing Address - Fax:
Practice Address - Street 1:30040 SW BOONES FERRY RD STE 20
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-8910
Practice Address - Country:US
Practice Address - Phone:503-682-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD114931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice