Hailu Solomon Mehanzel, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

62284 Issued in CA

Practice address

1031 Waterloo Rd
Stockton, CA 95205-4256

Phone

(209) 940-5600

Fax

(209) 940-5065

NPI assigned

Jul 24, 2013

Last updated

Feb 5, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Interoperability endpoints

• Direct secure messaging: hailu.mehanzel.p1@direct.cmcentersinc.nextgenshare.com

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1374624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1454630400000",
    "number": "1245672716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7210 MURRAY DR",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952103339",
            "telephone_number": "209-373-2800",
            "fax_number": "209-373-2878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1031 WATERLOO RD",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952054256",
            "telephone_number": "209-940-5600",
            "fax_number": "209-940-5065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEHANZEL",
        "first_name": "HAILU",
        "middle_name": "SOLOMON",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-07-24",
        "last_updated": "2016-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "62284",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Medmark Treatment Centers - Stockton, Inc.
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• Medsupply
• Stefan Jonathan Meers Estrada, PA-C
• Joshua Megli
• Mehdi Akhavan-Heidari MD Inc
• Aminder S Mehdi, MD
• Heena Mehendiratta, FNP
• Meherji Oshtory MD & Abha Oshtory MD a Professional Corp
• Mehnaz Inc

• General Practice Dentistry in Stockton, CA
• Providers in Stockton, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.