Healthcare Provider Details

I. General information

NPI: 1629737366
Provider Name (Legal Business Name): AHMAD JAWAD HAMOOD DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2021
Last Update Date: 06/28/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9449 LANDRUM ST
PLYMOUTH CA
95669-9025
US

IV. Provider business mailing address

10117 WEXTED WAY
ELK GROVE CA
95757-5501
US

V. Phone/Fax

Practice location:
  • Phone: 209-245-4413
  • Fax:
Mailing address:
  • Phone: 415-819-3206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number107171
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: