Healthcare Provider Details

I. General information

NPI: 1114088903
Provider Name (Legal Business Name): J H HAMADA DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 06/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1569 LEXANN AVE SUITE 218
SAN JOSE CA
95121-1795
US

IV. Provider business mailing address

1569 LEXANN AVE SUITE 216
SAN JOSE CA
95121-1794
US

V. Phone/Fax

Practice location:
  • Phone: 408-528-1131
  • Fax: 408-528-1151
Mailing address:
  • Phone: 408-528-1131
  • Fax: 408-528-1151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number40444
License Number StateCA

VIII. Authorized Official

Name: DR. JASON H HAMADA
Title or Position: DENTIST
Credential: D.D.S.
Phone: 408-528-1131