Provider Demographics
NPI:1811417348
Name:YAHYA, HAZZAA (DMD)
Entity Type:Individual
Prefix:
First Name:HAZZAA
Middle Name:
Last Name:YAHYA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3509 SWEETWATER SPRINGS BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91978-1064
Mailing Address - Country:US
Mailing Address - Phone:619-670-4471
Mailing Address - Fax:
Practice Address - Street 1:3509 SWEETWATER SPRINGS BLVD STE 1
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91978-1064
Practice Address - Country:US
Practice Address - Phone:619-670-4471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-26
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019312341223G0001X
CA103970122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice