Provider Demographics
NPI:1225635030
Name:HAKIM, CHANTAL (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:CHANTAL
Middle Name:
Last Name:HAKIM
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9201 W SUNSET BLVD STE 905
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90069-3710
Mailing Address - Country:US
Mailing Address - Phone:310-702-5989
Mailing Address - Fax:
Practice Address - Street 1:9201 W SUNSET BLVD STE 905
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90069-3710
Practice Address - Country:US
Practice Address - Phone:310-702-5989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1046061223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics