Provider Demographics
NPI:1497970719
Name:HASANY, ELY (DDS)
Entity Type:Individual
Prefix:
First Name:ELY
Middle Name:
Last Name:HASANY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6024 FALLBROOK AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-3242
Mailing Address - Country:US
Mailing Address - Phone:818-888-6860
Mailing Address - Fax:310-391-7166
Practice Address - Street 1:6024 FALLBROOK AVE STE 102
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-3242
Practice Address - Country:US
Practice Address - Phone:818-888-6860
Practice Address - Fax:818-888-6860
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA506051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD50605OtherDENTI-CAL