Healthcare Provider Details

I. General information

NPI: 1316017064
Provider Name (Legal Business Name): KHALID KAMEL HASHEM DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2745 W SHAW AVE SUITE 103
FRESNO CA
93711-3315
US

IV. Provider business mailing address

922 EZIE AVE
CLOVIS CA
93611-2017
US

V. Phone/Fax

Practice location:
  • Phone: 559-227-2900
  • Fax: 559-227-6203
Mailing address:
  • Phone: 559-298-1286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number50753
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: