Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 57538 | CA |
NPI | 1073764908 |
---|---|
Provider Name | Dr. Mohamed Abdalla Hassan |
First Address | Irvine, CA 92618 |
Second Address | Irvine, CA 92618-0825 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2008 |
Last Update Date | 21/03/2017 |