MEDICARE: DR. HANH IWAMURA DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	53039	CA

General Provider Information

NPI Number	:	1376547752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HANH IWAMURA DDS

Provider Business Mailing Address
First Line	:	777 12TH ST STE 250
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95814-1929
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	216 N LINCOLN WAY STE 10
Second Line	:
City	:	GALT
State	:	CA
Zip	:	95632-1715
Country	:	US
Telephone Number	:	209-259-2090
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	09/02/2020

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