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General NPI Number Information
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NPI Number | 1134621360
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Entity Type | Organization
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Legal Business Name | MOHAMED HAMMAM, BDS, INC
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Dates
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Enumeration Date | 03/03/2018
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Last Update Date | 03/03/2018
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Provider Practice Location Address
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Address Line | 1330 S VERMONT AVE
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City | LOS ANGELES
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State | CA
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Zip | 90006-4502
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Country | US
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Telephone | 213-383-7315
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Fax |
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Provider Business Mailing Address
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Address Line | 1127 E CHESTNUT ST APT B
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City | GLENDALE
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State | CA
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Zip | 91205-4426
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Country | US
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Telephone | 612-227-2101
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Fax |
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | DR. MOHAMED ABBAS HAMMAM
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Credential | DDS
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Telephone | 612-227-2101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 60616
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License Number State | CA
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