Provider Demographics
NPI:1003012857
Name:HUSSAINY, MIRWAIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:MIRWAIS
Middle Name:
Last Name:HUSSAINY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2607 MOUNDGLEN LN
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-6737
Mailing Address - Country:US
Mailing Address - Phone:310-920-1444
Mailing Address - Fax:
Practice Address - Street 1:2 MACARTHUR PL STE 700
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92707-7705
Practice Address - Country:US
Practice Address - Phone:714-708-5361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA524011223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery