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General NPI Number Information
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NPI Number | 1730076332
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Entity Type | Individual
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Provider Name | HASAN ABBOUD
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Gender | Male
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Dates
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Enumeration Date | 06/18/2025
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Last Update Date | 06/18/2025
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Provider Practice Location Address
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Address Line | 2004 W AVENUE J
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City | LANCASTER
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State | CA
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Zip | 93536-5913
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Country | US
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Telephone | 661-441-7011
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Fax |
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Provider Business Mailing Address
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Address Line | 13153 LA TIERRA WAY
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City | SYLMAR
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State | CA
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Zip | 91342-3466
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Country | US
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Telephone | 818-849-1964
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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 | 111649
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License Number State | CA
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