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General NPI Number Information
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NPI Number | 1073324141
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Entity Type | Individual
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Provider Name | AYAT HASAN
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Gender | Female
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Dates
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Enumeration Date | 01/16/2025
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Last Update Date | 04/07/2025
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Provider Practice Location Address
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Address Line | 27901 LA PAZ RD STE D
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City | LAGUNA NIGUEL
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State | CA
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Zip | 92677-3932
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Country | US
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Telephone | 714-728-1493
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Fax |
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Provider Business Mailing Address
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Address Line | 16009 LEGACY RD UNIT 403
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City | TUSTIN
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State | CA
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Zip | 92782-2806
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 110453
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License Number State | CA
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