Provider Demographics
NPI:1154494151
Name:HAU LEVINE & MALM,BERG, INC
Entity Type:Organization
Organization Name:HAU LEVINE & MALM,BERG, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:JORDAN
Authorized Official - Last Name:LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-246-8686
Mailing Address - Street 1:3924 WILLIAMS RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95117-2794
Mailing Address - Country:US
Mailing Address - Phone:408-246-8686
Mailing Address - Fax:408-246-8690
Practice Address - Street 1:3924 WILLIAMS RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95117-2794
Practice Address - Country:US
Practice Address - Phone:408-246-8686
Practice Address - Fax:408-246-8690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA268831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty