Provider Demographics
NPI:1285809335
Name:HABU, CHRIS (DDS)
Entity type:Individual
Prefix:
First Name:CHRIS
Middle Name:
Last Name:HABU
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 1:1431 S BURLINGTON AVE
Mailing Address - Street 2:APT. 6
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-5483
Mailing Address - Country:US
Mailing Address - Phone:213-458-4659
Mailing Address - Fax:
Practice Address - Street 1:1431 S BURLINGTON AVE
Practice Address - Street 2:APT. 6
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-5483
Practice Address - Country:US
Practice Address - Phone:213-458-4659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA441771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice