Healthcare Provider Details

I. General information

NPI: 1659158863
Provider Name (Legal Business Name): HASAN HARRIS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: HASAN HARITH KHALID AL KHUZAE AL KHUZAE

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12420 DAY ST STE B4
MORENO VALLEY CA
92553-7536
US

IV. Provider business mailing address

23031 S WATERLILY DR
RICHMOND TX
77406-8623
US

V. Phone/Fax

Practice location:
  • Phone: 951-656-6538
  • Fax:
Mailing address:
  • Phone: 128-143-5685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number109352
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: