MEDICARE: HENNA HUSSAIN DDS INC

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	122300000X	Dentist	60344	CA

General Provider Information

NPI Number	:	1740637974
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HENNA HUSSAIN DDS INC

Provider Business Mailing Address
First Line	:	2245 RIVER RUN DR APT 4202
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-5843
Country	:	US
Telephone Number	:	516-384-0898
Fax Number	:

Provider Business Practice Location Address
First Line	:	2245 RIVER RUN DR APT 4202
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-5843
Country	:	US
Telephone Number	:	516-384-0898
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. HENNA HUSSAIN
Credential	:	D.D.S
Telephone Number	:	516-384-0898

Provider Enumeration Date	:	05/18/2016
Last Update Date	:	05/18/2016

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