Provider Demographics
NPI:1205237872
Name:KHAKI, NOOR A (DMD)
Entity type:Individual
Prefix:DR
First Name:NOOR
Middle Name:A
Last Name:KHAKI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 SE DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-1058
Mailing Address - Country:US
Mailing Address - Phone:503-774-3033
Mailing Address - Fax:
Practice Address - Street 1:19029 S. BEAVERCREEK RD
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045
Practice Address - Country:US
Practice Address - Phone:503-941-3064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-14
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD10079122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500690740Medicaid