Provider Demographics
NPI:1912127093
Name:ALHASSAN, MELATH KHALID (DDS)
Entity Type:Individual
Prefix:DR
First Name:MELATH
Middle Name:KHALID
Last Name:ALHASSAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 E IMPERIAL AVE APT D
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-2381
Mailing Address - Country:US
Mailing Address - Phone:310-640-3204
Mailing Address - Fax:323-564-7767
Practice Address - Street 1:9849 ATLANTIC AVE
Practice Address - Street 2:SUITE 'F'
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-5268
Practice Address - Country:US
Practice Address - Phone:323-564-7777
Practice Address - Fax:323-564-7767
Is Sole Proprietor?:No
Enumeration Date:2007-04-30
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA482161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA48216OtherPROFESSIONAL LICENSE #
CAD48216OtherDENTICAL PROVIDER #
CAB6397862OtherCALIFORNIA DL