Basic Information
| Provider Information | |||||||||
| NPI: | 1669632824 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUSSAIN | ||||||||
| FirstName: | HENNA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3417 KEARNY VILLA LN | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921231912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5163840898 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1333 CAMINO DEL RIO S | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921083520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192604990 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2008 | ||||||||
| LastUpdateDate: | 03/16/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 60344 | CA | Y | Dental Providers | Dentist | General Practice | 1223G0001X | 019028201 | IL | N | Dental Providers | Dentist | General Practice | 1223G0001X | 054445-1 | NY | N | Dental Providers | Dentist | General Practice |
No ID Information.