Provider Demographics
NPI:1922145044
Name:HAMDAN, HADI D
Entity Type:Individual
Prefix:DR
First Name:HADI
Middle Name:D
Last Name:HAMDAN
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 1:4125 E VENTURA AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93702-3503
Mailing Address - Country:US
Mailing Address - Phone:559-312-7874
Mailing Address - Fax:559-578-4333
Practice Address - Street 1:4125 E VENTURA AVE STE 101
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93702-3503
Practice Address - Country:US
Practice Address - Phone:559-312-7874
Practice Address - Fax:559-325-6772
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47901122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD47901Medicaid