Provider Demographics
NPI:1063815256
Name:H. HADIDJAJA, DDS INC.
Entity Type:Organization
Organization Name:H. HADIDJAJA, DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:HADIDJAJA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-588-0001
Mailing Address - Street 1:3122 E FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-5830
Mailing Address - Country:US
Mailing Address - Phone:323-588-0001
Mailing Address - Fax:999-999-9999
Practice Address - Street 1:3122 E FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-5830
Practice Address - Country:US
Practice Address - Phone:323-588-0001
Practice Address - Fax:999-999-9999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-01
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41834122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty