Provider Demographics
NPI:1922713932
Name:HASAN, ASHJAN
Entity Type:Individual
Prefix:
First Name:ASHJAN
Middle Name:
Last Name:HASAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 N URSULA ST UNIT 129
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045-7420
Mailing Address - Country:US
Mailing Address - Phone:510-730-4965
Mailing Address - Fax:
Practice Address - Street 1:1931 E 20TH ST
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-8008
Practice Address - Country:US
Practice Address - Phone:530-961-5926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-16
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN00205445122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist