Provider Demographics
NPI:1417098062
Name:YOUSEF, HAZEM M (DDS)
Entity Type:Individual
Prefix:DR
First Name:HAZEM
Middle Name:M
Last Name:YOUSEF
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 1:73 CHULA VIS
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602-0951
Mailing Address - Country:US
Mailing Address - Phone:714-390-2260
Mailing Address - Fax:
Practice Address - Street 1:1718 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-2736
Practice Address - Country:US
Practice Address - Phone:714-543-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA493281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice