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General NPI Number Information
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NPI Number | 1629234802
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Entity Type | Organization
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Legal Business Name | HOMAN HANASAB D.D.S. INC.
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Dates
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Enumeration Date | 08/06/2008
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Last Update Date | 08/06/2008
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Provider Practice Location Address
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Address Line | 1580 MANNING AVE APT 302
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City | LOS ANGELES
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State | CA
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Zip | 90024-6086
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Country | US
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Telephone | 310-892-6631
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Fax |
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Provider Business Mailing Address
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Address Line | 1580 MANNING AVE APT 302
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City | LOS ANGELES
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State | CA
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Zip | 90024-6086
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Country | US
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Telephone | 310-892-6631
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | HOMAN HANASAB
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Credential |
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Telephone | 310-892-6631
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 53909
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License Number State | CA
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