MEDICARE: DR. LESLIE HATA D.D.S.

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	31795	CA

General Provider Information

NPI Number	:	1164429338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LESLIE HATA D.D.S.

Provider Business Mailing Address
First Line	:	5277 COLLEGE AVE
Second Line	:	SUITE 106
City	:	OAKLAND
State	:	CA
Zip	:	94618-1437
Country	:	US
Telephone Number	:	510-653-7012
Fax Number	:

Provider Business Practice Location Address
First Line	:	5277 COLLEGE AVE
Second Line	:	SUITE 106
City	:	OAKLAND
State	:	CA
Zip	:	94618-1437
Country	:	US
Telephone Number	:	510-653-7012
Fax Number	:

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

Provider Enumeration Date	:	07/03/2005
Last Update Date	:	04/20/2011

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