Healthcare Provider Details

I. General information

NPI: 1013828508
Provider Name (Legal Business Name): EZINNA IKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 SE 8TH AVE
HILLSBORO OR
97123-4218
US

IV. Provider business mailing address

5805 SE 51ST AVE
PORTLAND OR
97206-6126
US

V. Phone/Fax

Practice location:
  • Phone: 503-964-2729
  • Fax:
Mailing address:
  • Phone: 503-964-2729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: