MEDICARE: JANE LALHRUAISUAKI HALAM DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	112934	CA

General Provider Information

NPI Number	:	1154251940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANE LALHRUAISUAKI HALAM DDS

Provider Business Mailing Address
First Line	:	5550 CENTRAL AVE APT 4
Second Line	:
City	:	EL CERRITO
State	:	CA
Zip	:	94530-3401
Country	:	US
Telephone Number	:	510-925-7975
Fax Number	:

Provider Business Practice Location Address
First Line	:	11299 SAN PABLO AVE
Second Line	:
City	:	EL CERRITO
State	:	CA
Zip	:	94530-2184
Country	:	US
Telephone Number	:	510-925-7975
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2026
Last Update Date	:	05/22/2026

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