Healthcare Provider Details

I. General information

NPI: 1598286130
Provider Name (Legal Business Name): HANAN HEMEDA BDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2017
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 CENTENNIAL WAY STE 109
TUSTIN CA
92780-3708
US

IV. Provider business mailing address

901 W WHITTIER BLVD
LA HABRA CA
90631-3743
US

V. Phone/Fax

Practice location:
  • Phone: 714-795-3882
  • Fax:
Mailing address:
  • Phone: 714-421-4952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number107371
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: