Healthcare Provider Details

I. General information

NPI: 1811417348
Provider Name (Legal Business Name): HAZZAA YAHYA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2017
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3509 SWEETWATER SPRINGS BLVD STE 1
SPRING VALLEY CA
91978-1064
US

IV. Provider business mailing address

3509 SWEETWATER SPRINGS BLVD STE 1
SPRING VALLEY CA
91978-1064
US

V. Phone/Fax

Practice location:
  • Phone: 619-670-4471
  • Fax:
Mailing address:
  • Phone: 619-670-4471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number01931234
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number103970
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: