Provider Demographics
NPI:1780835520
Name:HABASHY, KEN NADER (DDS)
Entity Type:Individual
Prefix:
First Name:KEN
Middle Name:NADER
Last Name:HABASHY
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 1:1230 SAN FERNANDO RD
Mailing Address - Street 2:B
Mailing Address - City:SAN FERNANDO
Mailing Address - State:CA
Mailing Address - Zip Code:91340-3238
Mailing Address - Country:US
Mailing Address - Phone:818-365-1245
Mailing Address - Fax:818-365-7905
Practice Address - Street 1:1230 SAN FERNANDO RD
Practice Address - Street 2:B
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-3238
Practice Address - Country:US
Practice Address - Phone:818-365-1245
Practice Address - Fax:818-365-7905
Is Sole Proprietor?:No
Enumeration Date:2008-10-09
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35470122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist