Provider Demographics
NPI:1598438855
Name:HASAN, HASAN SALIH HASAN (DDS)
Entity Type:Individual
Prefix:
First Name:HASAN
Middle Name:SALIH HASAN
Last Name:HASAN
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 1:110 W 6TH ST UNIT 171
Mailing Address - Street 2:
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702-6716
Mailing Address - Country:US
Mailing Address - Phone:720-277-1269
Mailing Address - Fax:
Practice Address - Street 1:2471 COHASSET RD
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1315
Practice Address - Country:US
Practice Address - Phone:530-961-9288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-30
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1066021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice