Provider Demographics
NPI:1932261823
Name:HORMATI, ABBASALI (DDS)
Entity Type:Individual
Prefix:
First Name:ABBASALI
Middle Name:
Last Name:HORMATI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 PACIFIC COAST HWY
Mailing Address - Street 2:#18
Mailing Address - City:HARBOR CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90710-3544
Mailing Address - Country:US
Mailing Address - Phone:310-891-1820
Mailing Address - Fax:310-891-1820
Practice Address - Street 1:1111 PACIFIC COAST HWY
Practice Address - Street 2:#18
Practice Address - City:HARBOR CITY
Practice Address - State:CA
Practice Address - Zip Code:90710-3544
Practice Address - Country:US
Practice Address - Phone:310-891-1820
Practice Address - Fax:310-891-1820
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33296122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist