Healthcare Provider Details

I. General information

NPI: 1053807446
Provider Name (Legal Business Name): GYVE LAURENT HAMIDI DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2018
Last Update Date: 06/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 E OCEAN AVE
LOMPOC CA
93436
US

IV. Provider business mailing address

336 S CRESCENT DR
BEVERLY HILLS CA
90212-4503
US

V. Phone/Fax

Practice location:
  • Phone: 805-735-2702
  • Fax:
Mailing address:
  • Phone: 914-441-8395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number103745
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: