Provider Demographics
NPI:1922678945
Name:WAHBI, HUSSAM
Entity Type:Individual
Prefix:
First Name:HUSSAM
Middle Name:
Last Name:WAHBI
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 1:44950 VALLEY CENTRAL WAY STE 107
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-1507
Mailing Address - Country:US
Mailing Address - Phone:661-317-5369
Mailing Address - Fax:
Practice Address - Street 1:44950 VALLEY CENTRAL WAY STE 107
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93536-1507
Practice Address - Country:US
Practice Address - Phone:661-317-5369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-30
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1062281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice