Healthcare Provider Details

I. General information

NPI: 1083540629
Provider Name (Legal Business Name): GHAZI HAMATI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29121 NEWPORT RD STE 101
MENIFEE CA
92584-5121
US

IV. Provider business mailing address

25 VIA LUCCA APT H127
IRVINE CA
92612-0663
US

V. Phone/Fax

Practice location:
  • Phone: 951-228-9296
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number113131
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: