Healthcare Provider Details

I. General information

NPI: 1912848896
Provider Name (Legal Business Name): HABASHY DDS OMFS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 S GRAND AVE
LOS ANGELES CA
90015-3010
US

IV. Provider business mailing address

19300 RINALDI ST
PORTER RANCH CA
91326-1651
US

V. Phone/Fax

Practice location:
  • Phone: 213-742-5780
  • Fax:
Mailing address:
  • Phone: 205-662-3555
  • Fax: 866-939-9888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: JAMES HABASHY
Title or Position: OWNER
Credential: DDS
Phone: 205-662-3555