Provider Demographics
NPI:1225497464
Name:HAKIM, JACQUILINE HABASHY (DO)
Entity Type:Individual
Prefix:
First Name:JACQUILINE
Middle Name:HABASHY
Last Name:HAKIM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 N BEDFORD DR STE 303
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4320
Mailing Address - Country:US
Mailing Address - Phone:310-803-2461
Mailing Address - Fax:
Practice Address - Street 1:436 N BEDFORD DR STE 303
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4320
Practice Address - Country:US
Practice Address - Phone:310-803-2461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-16
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS14834207N00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology