Individual
DR. HATAI JIVAGUNCHAINAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
940 ASTOR ST STE C, ASTORIA, OR 97103-4213
(971) 206-6688
Mailing address
1111 N ROOSEVELT DR STE 110, SEASIDE, OR 97138-4603
(971) 704-7011
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D11301
OR
Other
Enumeration date
08/28/2020
Last updated
02/03/2021
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