Healthcare Provider Details

I. General information

NPI: 1154251940
Provider Name (Legal Business Name): JANE LALHRUAISUAKI HALAM DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11299 SAN PABLO AVE
EL CERRITO CA
94530-2184
US

IV. Provider business mailing address

5550 CENTRAL AVE APT 4
EL CERRITO CA
94530-3401
US

V. Phone/Fax

Practice location:
  • Phone: 510-925-7975
  • Fax:
Mailing address:
  • Phone: 510-925-7975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number112934
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: