Provider Demographics
NPI:1992464655
Name:MIKHA, ASMAHAN IBRAHEEM
Entity type:Individual
Prefix:
First Name:ASMAHAN
Middle Name:IBRAHEEM
Last Name:MIKHA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 TUCSON CT
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-5123
Mailing Address - Country:US
Mailing Address - Phone:480-658-8222
Mailing Address - Fax:
Practice Address - Street 1:2654 JAMACHA RD STE 113
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92019-4327
Practice Address - Country:US
Practice Address - Phone:619-303-0930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-09
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1071751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice