Provider Demographics
NPI:1164745766
Name:HAKIMPOUR DENTAL CORP, INC.
Entity Type:Organization
Organization Name:HAKIMPOUR DENTAL CORP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REZA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAKIMPOUR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-927-0600
Mailing Address - Street 1:6055 MERIDIAN AVE STE 60
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95120-2700
Mailing Address - Country:US
Mailing Address - Phone:408-927-0600
Mailing Address - Fax:
Practice Address - Street 1:6055 MERIDIAN AVE STE 60
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95120-2700
Practice Address - Country:US
Practice Address - Phone:408-927-0600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-10
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA431671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty