Provider Demographics
NPI:1306545587
Name:PENA, HANNAH CHESKA AMULAR (DDS)
Entity type:Individual
Prefix:
First Name:HANNAH CHESKA
Middle Name:AMULAR
Last Name:PENA
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 1:6318 SHIRLEY AVE
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-6548
Mailing Address - Country:US
Mailing Address - Phone:818-721-6059
Mailing Address - Fax:
Practice Address - Street 1:21830 NORDHOFF ST
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-5761
Practice Address - Country:US
Practice Address - Phone:818-727-7820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-27
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1104971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice