Provider Demographics
NPI:1386304335
Name:CHAHDA, HASSAN
Entity type:Individual
Prefix:
First Name:HASSAN
Middle Name:
Last Name:CHAHDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 CROWN ST
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-5308
Mailing Address - Country:US
Mailing Address - Phone:216-647-2137
Mailing Address - Fax:
Practice Address - Street 1:1240 CROWN ST
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-5308
Practice Address - Country:US
Practice Address - Phone:216-647-2137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-17
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107195122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA107195Medicaid