Healthcare Provider Details

I. General information

NPI: 1639462435
Provider Name (Legal Business Name): HANY M KURDI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2011
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 LAS POSAS RD
CAMARILLO CA
93010-1427
US

IV. Provider business mailing address

729 W 15TH ST
CHICAGO IL
60607-5139
US

V. Phone/Fax

Practice location:
  • Phone: 805-482-3214
  • Fax:
Mailing address:
  • Phone: 586-871-9873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019028712
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: