Provider Demographics
NPI:1669461802
Name:ALASSY, HATEM
Entity Type:Individual
Prefix:
First Name:HATEM
Middle Name:
Last Name:ALASSY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 BARRY AVE APT 101
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-3955
Mailing Address - Country:US
Mailing Address - Phone:714-580-4353
Mailing Address - Fax:
Practice Address - Street 1:1310 BARRY AVE APT 101
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-3955
Practice Address - Country:US
Practice Address - Phone:714-580-4353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND119921223G0001X
CA580911223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No1223G0001XDental ProvidersDentistGeneral Practice