Provider Demographics
NPI:1083014450
Name:HAKHAMIAN, ARDESHIR (DDS, MPHD)
Entity Type:Individual
Prefix:DR
First Name:ARDESHIR
Middle Name:
Last Name:HAKHAMIAN
Suffix:
Gender:M
Credentials:DDS, MPHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10530 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-7024
Mailing Address - Country:US
Mailing Address - Phone:323-569-5000
Mailing Address - Fax:323-569-4000
Practice Address - Street 1:10530 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-7024
Practice Address - Country:US
Practice Address - Phone:323-569-5000
Practice Address - Fax:323-569-4000
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-03
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63487122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist